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Remote Utilization Review Nurse Jobs in Bothell, WA

YO AI Labs

Hospitalist Physician - Remote

Seattle, WA · Remote

$70 - $100/hr

Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...

YO AI Labs

Hospitalist Physician - Remote

Seattle, WA · Remote

$70 - $100/hr

Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...

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

... 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 ...

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Remote Utilization Review Nurse information

See Bothell, WA salary details

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$47

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

As of Aug 28, 2026, the average hourly pay for remote utilization review nurse in Bothell, WA is $47.27, according to ZipRecruiter salary data. Most workers in this role earn between $37.36 and $54.28 per hour, depending on experience, location, and employer.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse?

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Bothell, WA as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $98,314 per year, or $47.3 per hour.

Sr Hospitalist Clinical Reviewer - Remote

YO AI Labs

Seattle, WA • Remote

$70 - $100/hr

Full-time

Posted 7 days ago

Job description

Senior Hospitalist Clinical Reviewer

Job Type: Contractor
Location: Remote

Job Overview

We are seeking experienced Senior Hospitalist Clinical Reviewers to support a high-impact project focused on inpatient clinical quality, documentation accuracy, and medical review. In this role, you will apply your hospitalist expertise and clinical judgment to evaluate inpatient cases, identify complex or ambiguous clinical scenarios, and provide clear, well-reasoned feedback.

This opportunity is ideal for experienced physicians with a strong background in hospital medicine, inpatient quality, medical auditing, clinical documentation, and quality assurance.

Key Responsibilities
  • Review inpatient cases for clinical quality, appropriate care, and documentation accuracy.
  • Evaluate clinical decisions and identify potential quality, documentation, or care concerns.
  • Apply advanced clinical judgment to complex, unusual, or ambiguous inpatient cases.
  • Provide clear and concise explanations supporting clinical review decisions.
  • Assess medical records, clinical documentation, and relevant supporting information.
  • Identify inconsistencies, gaps, or areas requiring clarification within clinical documentation.
  • Apply established clinical standards, guidelines, and quality frameworks when appropriate.
  • Contribute to the development and improvement of clinical review guidelines and quality standards.
  • Collaborate with project teams to resolve challenging clinical cases and review questions.
  • Maintain consistent, accurate, and high-quality review standards across assigned cases.
  • Work independently while meeting project timelines and quality expectations.
Required Qualifications
  • MD or DO degree.
  • 10+ years of attending-level hospitalist experience.
  • Strong experience in inpatient medicine and hospital-based clinical care.
  • Demonstrated experience with inpatient quality, clinical documentation review, medical auditing, or quality assurance.
  • Excellent clinical judgment and ability to evaluate complex or ambiguous cases.
  • Strong written and verbal communication skills.
  • Ability to clearly articulate clinical reasoning and support review decisions.
  • Strong attention to detail and ability to analyze medical records comprehensively.
  • Ability to work independently in a remote environment.
Preferred Qualifications
  • Experience leading or contributing to hospital quality improvement programs.
  • Experience with clinical documentation improvement (CDI).
  • Experience with medical coding, utilization review, or physician audit processes.
  • Experience developing or reviewing clinical quality standards.
  • Familiarity with hospital quality metrics and inpatient quality initiatives.
  • Previous experience mentoring physicians or participating in physician peer review.
Core Skills
  • Inpatient Quality
  • Quality Assurance
  • Medical Auditing
  • Hospital Medicine / Hospitalist Practice
  • Clinical Judgment
  • Clinical Documentation Review
  • Medical Record Review
  • Quality Improvement
  • Critical Thinking
  • Written and Verbal Communication
  • Attention to Detail