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Remote Utilization Review Manager Jobs in Seattle, WA

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

... processing Utilization Management (UM) organization determinations for services requiring ... Reviews completed denial letters for accuracy and adherence to compliance deadlines. Edits and ...

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 ...

Solid Rock Recruiting LLC

Remote Tax Manager

Seattle, WA · On-site +1

$135K - $195K/yr

Prepare and review: * Individual (1040), business (1120S, 1065), and basic corporate returns ... managing client relationships * Ability to work independently in a remote environment * Strong ...

Solid Rock Recruiting LLC

Remote Tax Manager

Bellevue, WA · On-site +1

$135K - $195K/yr

Prepare and review: * Individual (1040), business (1120S, 1065), and basic corporate returns ... managing client relationships * Ability to work independently in a remote environment * Strong ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Seattle, WA

Remote Utilization Review Manager information

See Seattle, WA salary details

$44.4K

$103.6K

$190.6K

How much do remote utilization review manager jobs pay per year?

As of Jul 26, 2026, the average yearly pay for remote utilization review manager in Seattle, WA is $103,573.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,700.00 and $124,600.00 per year, depending on experience, location, and employer.

What are some common challenges faced by a Remote Utilization Review Manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Manager, and why are they important?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are the most commonly searched types of Remote Utilization Review jobs in Seattle, WA? The most popular types of Remote Utilization Review jobs in Seattle, WA are:
What are popular job titles related to Remote Utilization Review Manager jobs in Seattle, WA? For Remote Utilization Review Manager jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Seattle, WA look for? The top searched job categories for Remote Utilization Review Manager jobs in Seattle, WA are:
What cities near Seattle, WA are hiring for Remote Utilization Review Manager jobs? Cities near Seattle, WA with the most Remote Utilization Review Manager job openings:
Remote Utilization Review Manager jobs near you

Utilization Management Coordinator I

CHPW

Seattle, WA • On-site, Remote

$21 - $28.98/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Job description

Who we are
Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:
  • Strive to apply an equity lens to all our work.
  • Reduce health disparities.
  • Create an equitable work environment.

About the Role:
The level I UM Coordinator is responsible for administrative functions in processing Utilization Management (UM) organization determinations for services requiring authorization and hospital notification. Utilizing knowledge of Medicare and Medicaid guidelines to facilitate and comply with the UM processes in data entry of authorization requests, eligibility verification, benefit determinations, timely letter fulfilment, and support to UM clinical staff.
To be successful in this role, you:
  • Have an associate degree, or an equivalent combination of education and highly relevant experience.
  • Have at least one (1) year of customer service experience, preferred.
  • Have working experience in a Healthcare setting, preferred.
  • Have working experience in a Managed Care setting, preferred.
  • Are knowledgeable of medical terminology and healthcare processes, preferred.
  • Are knowledgeable of Washington Apple Health and Medicare Advantage Plans, preferred.

Essential functions and Roles and Responsibilities:
  • Performs data entry for all referral, prior authorizations and hospital notifications; attaches and/or includes clinical documents as needed.
  • Utilizes knowledge to determine appropriate CPT, HCPC, ICD-10 codes using CMS, NCQA and HCA criteria.
  • Researches and validates benefit and prior authorization requirements to determine appropriate course of action within the Care Management system.
  • Reviews, corrects, and approves authorization requests via the web portal; determines appropriate level of complexity and refers cases requiring clinical review to a nurse reviewer.
  • Reviews completed denial letters for accuracy and adherence to compliance deadlines. Edits and proofreads content for appropriate medical terminology and MCG criteria. Ensures letters are mailed within established timeframes.
  • Accurately applies policies & procedures, benefit and eligibility standards to all incoming requests.
  • Conducts research, validates data, and responds to complex inquiries from multiple sources, including but not limited to members, nurses, medical providers, customer service, operations, appeals, case management and care coordination. Escalating issues as needed.
  • Reporting to work on time and for all scheduled shifts is essential to this position.
  • Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:
  • Solid analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
  • Knowledge of care management workflow systems.
  • Effective verbal and written communication skills. Able to communicate with and collaborate effectively with physicians and allied health care providers.
  • Flexibility and willingness to work in a matrix-management environment.
  • Demonstrated organizational, time management, and project management skills.
  • Ability to multi-task and deal with complex assignments on a frequent basis.
  • Demonstrated proficiency and experience with Microsoft Office products.
  • Ability to work independently.
  • Collaborate with others in a respectful manner and ability to maintain confidentiality.
  • Perform all functions of the job with accuracy, attention to detail and within established timeframes.

As part of our hiring process, the following criteria must be met:
  • Complete and successfully pass a criminal background check

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
  • Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
  • Vaccination requirement (CHPW offers a process for medical or religious exemptions)
  • Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:
The position is FLSA Non-Exempt and is not eligible for overtime. Based on market data, this position grade is 38 (see full range below) and has a 5% annual incentive target based on company, department, and individual performance goals.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
  • Medical, Prescription, Dental, and Vision
  • Telehealth app
  • Flexible Spending Accounts, Health Savings Accounts
  • Basic Life AD&D, Short and Long-Term Disability
  • Voluntary Life, Critical Care, and Long-Term Care Insurance
  • 401(k) Retirement and generous employer match
  • Employee Assistance Program and Mental Fitness app
  • Financial Coaching, Identity Theft Protection
  • Time off including PTO accrual starting at 17 days per year.
  • 40 hours Community Service volunteer time
  • 10 standard holidays, 2 floating holidays
  • Compassion time off, jury duty

Sensory/Physical/Mental Requirements:
Sensory*:
  • Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:
  • Extended periods of sitting, computer use, talking and possibly standing
  • Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
  • Frequent torso/back static position; occasional stooping, bending, and twisting.
  • Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:
  • Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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