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Remote Utilization Review Rn Jobs in Bothell, 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 ...

Providence

Physician Advisor | Remote

Seattle, WA · On-site +1

$331K - $373K/yr

Strong understanding of utilization review and clinical documentation integrity Where You'll Work ... Remote Care - Teladoc Brand Name: Swedish Provider Profession: Physician/Surgeon Medical Specialty:

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Remote Utilization Review Rn information

See Bothell, WA salary details

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$47

$77

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

As of Jun 29, 2026, the average hourly pay for remote utilization review rn 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 the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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 Bothell, WA? For Remote Utilization Review Rn jobs in Bothell, WA, the most frequently searched job titles are:
What cities near Bothell, WA are hiring for Remote Utilization Review Rn jobs? Cities near Bothell, WA with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you

Utilization Review Coordinator

Guidelight Health

Seattle, WA • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Job description

Guidelight Health is a cutting-edge behavioral healthcare company dedicated to transforming lives through high-quality PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program) services. As a newly launched organization, we are on a mission to redefine the behavioral health industry by delivering exceptional care, utilizing state-of-the-art facilities, and prioritizing the well-being of those we serve. At Guidelight Health, we are building a team of passionate, forward-thinking professionals who are eager to be part of this exciting journey to reshape mental health care. Join us in making a lasting impact!

Title: Utilization Review Coordinator

Reports to: Director of Revenue Cycle Management

Department/Location: Remote, but only considering candidates in PST.

FLSA Status: Exempt

Travel Requirement: None

Summary:

Reporting directly to the Director of Revenue Cycle Management, this team member plays an essential role in helping clients access and continue the care they need. They will be responsible for handling pre-certifications, authorizations, retro-authorizations, appeals, medical records requests, and chart auditing duties that support accurate reporting of each client's clinical level of care, program participation, and treatment days utilized. As a subject matter expert on payor requirements and expectations, particularly across the WA and CA markets, this individual will partner closely with clinical and revenue cycle teams to remove administrative barriers, optimize utilization review outcomes, and support Guidelight's mission of delivering accessible, high-quality behavioral healthcare.

Responsibilities:

  • Utilization Review on Behalf of the Clinics:
    • Prescreen referrals to project/anticipate authorizations. Provide recommendations regarding level of care/services and treatment planning.
    • Conduct live reviews with payors and level of care chart reviews, conceptualizing the clinical presentation and care needs and applying medical necessity guidelines and /or LOCUS to compel authorization.
    • Clinically negotiate authorization outcomes with the payor, collaborating in advance with the primary treating clinicians.
    • Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling. Provide guidance and training to clinicians on completing P2P reviews.
    • Establish internal authorization or denial determinations for No Authorization Required (NAR) requests.
    • Establish post denial appeal response recommendations.
    • Obtain portal access to any utilization review portals for an efficient and scalable process.
  • Interdepartmental Relations and Communication:
    • Coordinate with the clinical team on requests with clinically weaker presentations.
    • Coordinate all concurrent insurance reviews with clinicians and medical team.
    • Provide guidance on specific interventions or areas on which to focus to result in maximum authorized days.
    • Provide ongoing feedback and recommendations for improvement to meet payor medical necessity guidelines.
    • Attend and participate in daily huddles/weekly rounds as the payor expert to ensure appropriate authorization outcomes and provide ongoing education regarding payor requirements.
    • Communicate with relevant parties at the facility and in RCM about any issues with coverage or denials, facilitating client notifications as needed.
    • Partner with intake, utilization review, and finance for best practices in overarching company goals related to RCM.
    • Timely completion of the Denial Notification process.
  • Accurate Data Entry:
    • Document deficiencies for identification on the daily reporting
    • Timely documentation of authorization in KIPU/Avea
    • Upload authorization letters to KIPU/Avea UR module.
  • Clinical Auditing:
    • Notify the primary therapist of any missing documentation or delinquent services
    • Review medical records for quality clinical documentation and compliance with licensing, accrediting, and payor requirements
    • Running daily reports to ensure that all information needed for timely review has been entered into the EMR and communicating with the clinic team members to correct or update any missing or incorrect documentation.
  • Policy Compliance:
    • Ensuring compliance with legal, regulatory, and policy requirements.
  • Process Improvement:
    • Identifying Clinical problems and proposing innovative solutions.
  • Additional job duties as assigned.

Qualifications:

  • Bachelor's degree in Social Work, Nursing, or any related field.
  • Must be based in PST, with an understanding of the west coast Payer landscape, specifically CA or WA.
  • 2-3+ years of UR experience in behavioral health, ideally across PHP or IOP levels of care.
  • Knowledge of medical necessity criteria, payer authorization processes, documentation standards, and regulatory requirements.
  • Proficient in MS Office applications and ability to learn department and job-specific software systems (e.g., applicable practice management and EMR systems)
  • Strong organizational, communication, analytical, and problem-solving skills with exceptional attention to detail.
Pay Range
$70,000—$80,000 USD

Benefits & Perks

At Guidelight, we value a work-life integration culture. This approach allows our teammates to focus on what matters most to them, while also caring for our clients and fellow teammates. We have found that this promotes a sustainable and successful culture, and we offer the following benefits to our teammates to demonstrate this commitment to each other. 

As a Guidelight teammate, working 32+ hours per week, you'll enjoy a comprehensive benefits package, including:

  • Health & Wellness: Medical, dental, vision, HealthJoy unlimited therapy, UHC wellness program, HSA/FSA options, and pet insurance.
  • Time Off: Responsible PTO, in lieu of a traditional accrual-based policy, which allows full-time and part-time employees to take the time they need, when they need it, while ensuring continuity of care and team collaboration
  • 401(k): With company match.
  • Licensing: All licensing fees covered, including opportunities for cross-licensure when applicable.
  • Professional Development: Annual stipend for tuition reimbursement, ongoing education, or CEUs.
  • Clinical Supervision & Growth: Pre-licensed clinicians receive structured clinical supervision toward licensure, and all clinicians benefit from best-in-class supervision grounded in our state-of-the-art PHP/IOP curriculum.