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Remote Optum Utilization Review Jobs in Seattle, WA

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... utilization review or prior authorization in a hospital, provider, or healthcare system. Healthcare medical billing and reimbursement Remote in Washington State only Posted wage ranges represent the ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... utilization review or prior authorization in a hospital, provider, or healthcare system. Healthcare medical billing and reimbursement Remote in Washington State only Posted wage ranges represent the ...

Karius

Clinical Sales Manager (Seattle)

Seattle, WA · On-site +1

... and utilization review. • Secure contracts and agreements, where necessary or optimal, to ... remote and in-person, and manage follow-up. • Collaborate with Customer Success to onboard new ...

Karius

Clinical Sales Manager (Seattle)

Seattle, WA · Remote

$118K - $177K/yr

... and utilization review. * Secure contracts and agreements, where necessary or optimal, to ... remote and in-person, and manage follow-up. * Collaborate with Customer Success to onboard new ...

UnitedHealth Group

Wellness Coordinator

Seattle, WA · Remote

REMOTE IN WA Optum is a global organization that delivers care, aided by technology to help ... Experience working in an environment that requires coordination of benefits and utilization of ...

Proliance Surgeons

Remote Coder (CPC)

Seattle, WA · On-site +1

$24.70 - $44.46/hr

Reviews/audits and interprets medical record documentation to identify pertinent diagnosis ... Demonstrates appropriate utilization of coding software and coding reference material. * Follow up ...

Prime Therapeutics

Regulatory Analyst Sr (Remote)

Home, WA · Remote

$81K - $138K/yr

... utilization and/or medication therapy management, network management, client delegation agreements ... Participate in Regulatory Review Committee Meetings, Healthcare Reform Meetings, Regulatory ...

New

CHPW

State Hospital Liaison

Seattle, WA · On-site +1

$41.05 - $64.45/hr

This position is remote. However, the candidate will need to reside in Washington State in order to ... Review requests for Behavioral Health Wraparound Care (BHWC). * Review requests and create ...

Dura Digital

VP, Delivery & Customer Success

Seattle, WA · Remote

$157K - $202K/yr

Conduct ongoing reviews, retrospectives, and feedback loops to continuously strengthen customer ... Own delivery financials, including project profitability, margin targets, utilization, forecasting ...

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All JobsOptum Utilization Review JobsRemote Optum Utilization Review JobsRemote Optum Utilization Review Jobs in Seattle, WA

Remote Optum Utilization Review information

See Seattle, WA salary details

$24

$48

$78

How much do remote optum utilization review jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for remote optum utilization review in Seattle, WA is $48.12, according to ZipRecruiter salary data. Most workers in this role earn between $38.03 and $55.24 per hour, depending on experience, location, and employer.

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review nurse?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What are the most commonly searched types of Optum Utilization Review jobs in Seattle, WA? The most popular types of Optum Utilization Review jobs in Seattle, WA are:
What are popular job titles related to Remote Optum Utilization Review jobs in Seattle, WA? For Remote Optum Utilization Review jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Seattle, WA look for? The top searched job categories for Remote Optum Utilization Review jobs in Seattle, WA are:
What cities near Seattle, WA are hiring for Remote Optum Utilization Review jobs? Cities near Seattle, WA with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Seattle, WA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 10% Hybrid, and 90% Remote job distribution, with an average salary of $100,085 per year, or $48.1 per hour.

Denial Management Specialist

Evergreen Health

Kirkland, WA • Remote

$28.83 - $46.14/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 24 days ago

Job description

Wage Range: $28.83 - $46.14 per hour
5 years of experience in denial management, utilization review or prior authorization in a hospital, provider, or healthcare system.
Healthcare medical billing and reimbursement
Remote in Washington State only
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:
Responsible for the review, appeal strategy, resolution and reporting of payer claim denials to recover reimbursement for EvergreenHealth. Maintains accountability for final appeal determinations and financial outcomes of assigned denials, including validation of triage decisions and direction of appeal activities. Analyzes denial trends, develops appeal strategies, collaborates with clinical and operational departments, and maintains detailed documentation throughout the appeal lifecycle. Communicates with payer representatives, contributes to denial prevention efforts, and adapts to evolving payer policies and system upgrades.
Primary Duties:
1. Reviews and validates recommended next steps for referred claim denials. Maintains final responsibility for appeal strategy and financial outcome.
2. Maintains accurate documentation of denial activity and appeal actions in electronic medical record (EMR) system and supporting tools.
3. Develops appeal strategy and drafts and submits timely appeals supported by documentation, clinical input, and payer criteria.
4. Collaborates with departments including Case Management, Coding, and Health Information Management (HIM) to gather supporting documentation that will strengthen the appeals.
5. Refers complex or escalated denials to senior team members or leadership as appropriate.
6. Reviews and validates denial trends and communicates payer feedback to promote consistency in documentation, appeal strategy, and resolution processes.
7. Monitors payer websites for changes in reimbursement requirements that impact denial management processes.
8. Participates in training focused on denial trends, payer-specific appeal strategies, and continuous learning around EMR tools.
9. Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIREDfor the position:
Associate's degree in related area or equivalent combination of education and experience
5 years of experience in denial management, utilization review or prior authorization in a hospital, provider, or healthcare system.
Experience in healthcare billing and reimbursement
Experience with EMR system workflows
Strong knowledge of health care services reimbursement methodologies
Knowledge of claim forms and remittance advices, including coding and billing practices
Ability to interpret contract language
Working knowledge of medical terminology

DESIREDfor the position:
Bachelor's degree
Previous training experience and knowledge of adult learning
Experience with Epic EMR

Benefit Information:
Choices that care for you and your family
At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
  • Medical, vision and dental insurance
  • On-demand virtual health care
  • Health Savings Account
  • Flexible Spending Account
  • Life and disability insurance
  • Retirement plans (457(b) and 401(a) with employer contribution)
  • Tuition assistance for undergraduate and graduate degrees
  • Federal Public Service Loan Forgiveness program
  • Paid Time Off/Vacation
  • Extended Illness Bank/Sick Leave
  • Paid holidays
  • Voluntary hospital indemnity insurance
  • Voluntary identity theft protection
  • Voluntary legal insurance
  • Pay in lieu of benefits premium program
  • Free parking
  • Commuter benefits

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.

Kirkland Employee Benefits | Kirkland, WA | EvergreenHealth

Employment Type: Full-Time
Evergreen Health logo

About Evergreen Health

Sourced by ZipRecruiter

Evergreen Health, located in Buffalo, NY, US, is a reputable organization in the healthcare industry. Established in 1983 initially as an AIDS Service Organization, it has continually evolved to meet the diverse health needs of the individuals it serves. Their objective extends beyond just providing medical care, as they believe in fostering an environment that promotes comprehensive health, wellness and recovery. The website, evergreenhs.org, provides an insight into their extensive range of services including primary and specialty medical care, supportive services, pharmacy services, community health, behavioral health, and substance use disorders services.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Buffalo, NY, US

Year founded

1983

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