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Remote Utilization Review Rn Jobs in Seattle, WA

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 ...

Appeals Pharmacist (Remote)

Bothell, WA · On-site +1

$66 - $80.50/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Appeals Pharmacist (Remote)

Redmond, WA · On-site +1

$64 - $78/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

A deep familiarity with reviewing childhood immunization records and schedules is essential for ... A Valid / Active DOH RN Credential is required, No NLC(Washington State DOES NOT participate in the ...

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Remote Utilization Review Rn information

See Seattle, WA salary details

$24

$48

$78

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

As of Jul 6, 2026, the average hourly pay for remote utilization review rn in Seattle, WA is $48.12, according to ZipRecruiter salary data. Most workers in this role earn between $38.03 and $55.24 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 the most commonly searched types of Utilization Review Rn jobs in Seattle, WA? The most popular types of Utilization Review Rn jobs in Seattle, WA are:
What cities near Seattle, WA are hiring for Remote Utilization Review Rn jobs? Cities near Seattle, WA with the most Remote Utilization Review Rn job openings:
Infographic showing various Remote Utilization Review Rn job openings in Seattle, WA as of July 2026, with employment types broken down into 85% Full Time, 11% Part Time, 1% Temporary, and 3% Contract. Highlights an 40% Physical, 4% Hybrid, and 56% Remote job distribution, with an average salary of $100,085 per year, or $48.1 per hour.
Denial Management Specialist

Denial Management Specialist

EvergreenHealth

Kirkland, WA • Remote

$28.83 - $46.14/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago


Job description

Wage Range: $28.83 - $46.14 per hour
5 years of experience in denial management, 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 entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:  
Responsible for the review, appeal strategy, resolution and reporting of payer claim denials to recover reimbursement for EvergreenHealth. Maintains accountability for final appeal determinations and financial outcomes of assigned denials, including validation of triage decisions and direction of appeal activities. Analyzes denial trends, develops appeal strategies, collaborates with clinical and operational departments, and maintains detailed documentation throughout the appeal lifecycle. Communicates with payer representatives, contributes to denial prevention efforts, and adapts to evolving payer policies and system upgrades.
Primary Duties:  
1. Reviews and validates recommended next steps for referred claim denials. Maintains final responsibility for appeal strategy and financial outcome.
2. Maintains accurate documentation of denial activity and appeal actions in electronic medical record (EMR) system and supporting tools.
3. Develops appeal strategy and drafts and submits timely appeals supported by documentation, clinical input, and payer criteria.
4. Collaborates with departments including Case Management, Coding, and Health Information Management (HIM) to gather supporting documentation that will strengthen the appeals.
5. Refers complex or escalated denials to senior team members or leadership as appropriate.
6. Reviews and validates denial trends and communicates payer feedback to promote consistency in documentation, appeal strategy, and resolution processes.
7. Monitors payer websites for changes in reimbursement requirements that impact denial management processes.
8. Participates in training focused on denial trends, payer-specific appeal strategies, and continuous learning around EMR tools.
9. Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIRED
 for the position:
● Associate's degree in related area or equivalent combination of education and experience
● 5 years of experience in denial management, utilization review or prior authorization in a hospital, provider, or healthcare system.
● Experience in healthcare billing and reimbursement
● Experience with EMR system workflows
● Strong knowledge of health care services reimbursement methodologies
● Knowledge of claim forms and remittance advices, including coding and billing practices
● Ability to interpret contract language
● Working knowledge of medical terminology

DESIRED
 for the position:
● Bachelor's degree
● Previous training experience and knowledge of adult learning
● Experience with Epic EMR

Benefit Information:
Choices that care for you and your family  
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.  
  • Medical, vision and dental insurance 
  • On-demand virtual health care 
  • Health Savings Account 
  • Flexible Spending Account 
  • Life and disability insurance 
  • Retirement plans (457(b) and 401(a) with employer contribution) 
  • Tuition assistance for undergraduate and graduate degrees 
  • Federal Public Service Loan Forgiveness program 
  • Paid Time Off/Vacation 
  • Extended Illness Bank/Sick Leave 
  • Paid holidays 
  • Voluntary hospital indemnity insurance 
  • Voluntary identity theft protection 
  • Voluntary legal insurance 
  • Pay in lieu of benefits premium program 
  • Free parking 
  • Commuter benefits  
View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. 
EvergreenHealth Benefits Guide 
 

EvergreenHealth logo

About EvergreenHealth

Sourced by ZipRecruiter

At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

Industry

Hospitals

Company size

1,001 - 5,000 Employees

Headquarters location

Kirkland, WA, US

Year founded

1972