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Remote Utilization Review Rn Jobs in Bellevue, WA

CHPW

Utilization Management Clinician I

Seattle, WA · On-site +1

$35.92 - $55.67/hr

Have a current, unrestricted license as an RN or LPN. * Have at least two years clinical experience ... Conduct review of hospital notification or prior authorization care requests against established ...

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

The level I UM Coordinator is responsible for administrative functions in processing Utilization ... nurse reviewer. * Reviews completed denial letters for accuracy and adherence to compliance ...

CHPW

State Hospital Liaison

Seattle, WA · On-site +1

$41.05 - $64.45/hr

Have a current, unrestricted clinical license in the State of Washington as an RN, ARNP, Social ... Review requests for Behavioral Health Wraparound Care (BHWC). * Review requests and create ...

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 ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Bellevue, WA

Remote Utilization Review Rn information

See Bellevue, WA salary details

$23

$47

$77

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

As of Jul 24, 2026, the average hourly pay for remote utilization review rn in Bellevue, WA is $47.42, according to ZipRecruiter salary data. Most workers in this role earn between $37.45 and $54.47 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Bellevue, WA? For Remote Utilization Review Rn jobs in Bellevue, WA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Bellevue, WA look for? The top searched job categories for Remote Utilization Review Rn jobs in Bellevue, WA are:
What cities near Bellevue, WA are hiring for Remote Utilization Review Rn jobs? Cities near Bellevue, WA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Bellevue, WA as of July 2026, with employment types broken down into 74% Full Time, 9% Part Time, and 17% Contract. Highlights an 52% Physical, 3% Hybrid, and 45% Remote job distribution, with an average salary of $99,260 per year, or $47.7 per hour.

Utilization Management Clinician I

CHPW

Seattle, WA • On-site, Remote

$35.92 - $55.67/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

This position is remote in Washington state.
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 Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient's condition. Supports physician decision-making, working collaboratively with all members of the health care team, the patient, the patient's family, co-workers, and internal and external customers to achieve optimal patient outcomes. Ensures members have timely access to care and supports during transitions between levels of care. Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.
To be successful in this role, you:
  • Have a bachelor's degree in a relevant field or an equivalent combination of education and highly relevant experience.
  • Have a current, unrestricted license as an RN or LPN.
  • Have at least two years clinical experience in either a physical health or behavioral health setting.
  • Have previous experience in Utilization Management and Managed Care, preferred.

Essential functions and Roles and Responsibilities:
  • Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies.
  • Conduct onsite visits to local facilities 1-3 times weekly to connect with members and support successful post-discharge transitions.
  • Collaborate with facilities to perform discharge planning.
  • Provide coordination support to members transitioning between care settings or returning home from a hospitalization. Identifies member needs and provides support to ensure necessary services are available during the transition period.
  • Collaborates with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
  • Identifies, coordinates, and ensures high quality care and appropriate care by focusing on supporting access to care and services across the continuum of care in accordance with the patient's medical needs.
  • Identify potentially unnecessary services and/or delivery settings and recommends appropriate alternatives.
  • Identifies and determines medical necessity of out of network (OON) requests for services.
  • Assures referrals are complete and enrollment/eligibility benefits verified, prior to authorizing care.
  • Delivers timely written notification to patient or family members and communicates with members of the health care team.
  • Prepare cases that do not meet medical necessity or criteria for medical director review.
  • Communicate effectively with medical director regarding identified variances within the case against criteria utilized for medical review.
  • Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for support, problem resolution and notification of decertification and appeals.
  • Using established screening tools, identify candidates and recommend enrollment into care management and disease management programs.
  • Identify quality of care issues and report for investigation per CHPW's policy.
  • Participates as part of the care management team; works collaboratively with all department staff.
  • 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:
  • Ability to effectively manage and maintain quality standards for high volume of authorization.
  • Ability to work independently.
  • Effective written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
  • Knowledge in criteria set, including MCG, InterQual, ASAM, and LOCUS preferred.
  • Ability to multi-task and deal with complex assignments with competing priorities on a frequent basis.
  • Perform all functions of the job with accuracy, attention to detail and within established timeframes.
  • Effective analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
  • Experience in care management workflow systems.
  • Flexibility and willingness to work in a matrix-management environment.
  • Demonstrated organizational, time management, and project management skills.
  • Demonstrated proficiency and experience with Microsoft Office products.
  • Ability to present in a group setting.
  • Willingness to be part of a collaborative and dynamic clinical development team.
  • Collaborate with others in a respectful manner and ability to maintain confidentiality.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
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.
  • 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 eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
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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