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Remote Utilization Review Rn Jobs in Kirkland, WA

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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Remote Utilization Review Rn information

See Kirkland, WA salary details

$24

$48

$78

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

As of Jul 26, 2026, the average hourly pay for remote utilization review rn in Kirkland, WA is $48.07, according to ZipRecruiter salary data. Most workers in this role earn between $37.98 and $55.19 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 Kirkland, WA? For Remote Utilization Review Rn jobs in Kirkland, WA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Kirkland, WA look for? The top searched job categories for Remote Utilization Review Rn jobs in Kirkland, WA are:
What cities near Kirkland, WA are hiring for Remote Utilization Review Rn jobs? Cities near Kirkland, 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 Kirkland, WA as of July 2026, with employment types broken down into 85% Full Time, 10% Part Time, and 5% Contract. Highlights an 59% Physical, 4% Hybrid, and 37% Remote job distribution, with an average salary of $99,992 per year, or $48.1 per hour.

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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