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Utilization Case Manager Jobs in Federal Way, WA

Kaiser Permanente

Liaison Nurse

Renton, WA · On-site

... this case,, including medication management of specific chronic conditions, focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care ...

Kaiser Permanente

Liaison Nurse

Renton, WA · On-site

$48.57/hr

... this case,, including medication management of specific chronic conditions, focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care ...

CommonSpirit Health

Care Manager RN

Tacoma, WA · On-site

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

VMFH Division Support Services

Care Manager RN

Tacoma, WA · On-site

$50.25 - $97.78/hr

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

VMFH Division Support Services

Care Manager RN

Tacoma, WA · On-site

$50.25 - $97.78/hr

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

CommonSpirit Health

Care Manager RN

Tacoma, WA · On-site

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

CommonSpirit Health

Care Manager RN ACO

Tacoma, WA · On-site

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

New

CommonSpirit Health

Care Manager RN ACO

Tacoma, WA · On-site

Experience with utilization management, discharge planning and/or case management * Accredited Case Manager, upon hire or * Case Management Nurse, upon hire or * Certified Case Manager, upon hire or

New

Pacs

Case Manager - LVN (I)

Pacific, WA · On-site

$30.25 - $40.75/hr

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Certificate as a certified Case Manager (CCM) a plus. * Must maintain all required continuing ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Federal Way, WA

Utilization Case Manager information

See Federal Way, WA salary details

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How much do utilization case manager jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization case manager in Federal Way, WA is $40.75, according to ZipRecruiter salary data. Most workers in this role earn between $33.03 and $42.93 per hour, depending on experience, location, and employer.

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What job categories do people searching Utilization Case Manager jobs in Federal Way, WA look for?

The top searched job categories for Utilization Case Manager jobs in Federal Way, WA are:

What cities near Federal Way, WA are hiring for Utilization Case Manager jobs?

Cities near Federal Way, WA with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

Liaison Nurse

Kaiser Permanente

Renton, WA • On-site

Full-time

Medical

Posted 5 days ago

Kaiser Permanente rating

8.2

Company rating: 8.2 out of 10

Based on 927 frontline employees who took The Breakroom Quiz

55th of 898 rated healthcare providers

Job description

**  CASE MANAGER LIAISON NURSE - OUTPATIENT COMPLEX CARE COORDINATION - PEDIATRICS!  **
MUST LIVE IN WESTERN WA WITHIN COMMUTABLE DISTANCE TO A KPWA MEDICAL CENTER
** FLEXIBLE ROLE WORKING  4-10'S  ~  (3) DAYS ONSITE KPWA MEDICAL CENTER AND (1) DAY REMOTE  ~  MON - FRI  7:00AM - 5:30PM  **
KPWA MEDICAL CENTER PRIMARY WORK SITE WILL BE BASED ON GEOGRAPHICAL LOCATION OF FINALIST SELECTED
PEDIATRICS EXPERIENCE HIGHLY PREFERRED
 
The Complex Case Manager in this position will work in a designated clinic setting 3 days per week and will telecommute remaining days in the work week.  Primary responsibility is to provide and coordinate nursing care for the member in collaboration with the Health Care team = Pediatrics in this case,, including medication management of specific chronic conditions, focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources.  Will be working closely with Pediatric/Family Care teams and specialty care teams and medical providers - the liaison nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status and improved ability to self-manage.  Participate in medication management through well-established protocols within internal delivery systems.
 
Job Summary:
The Care Manager will work in two settings on a periodic rotating schedule, planning the discharges and follow up care for Kaiser Foundation Health Plan of Washington patients hospitalized at a nearby network facility and carrying a case load of patients in one of the Kaiser Foundation Health Plan of Washington medical centers. Some weekends and holidays are required, and scheduled days of the week are variable. Primary responsibility is to focus on achievement of optimal patient health care outcomes while ensuring appropriate utilization of health care resources. Working closely with primary care teams, specialty care teams and medical providers, the Liaison Nurse will establish a collaborative plan of care to assure adherence to the medical plan, improvement in functional status, and improved ability to self-manage. Serves as the liaison across the internal KFHPW care continuum and between KFHPW and all externally contracted providers, facilities, and resources and provides feedback to the organization regarding the service and quality of contracted services. The Liaison Nurse collects data and provides input to leadership regarding issues or concerns related to utilization, cost, quality, service and care delivery to patients.

Essential Responsibilities:
  • Ensures patients referred to case management meet established case management criteria. Assess all patients referred for case management to determine physical, mental, financial, psychosocial status, utilizing comprehensive, standardized criteria to identify existing and potential needs. Develop patient centered case management plan based on assessments and including patient goals, objectives, and outcomes with specific time frames (long/short term). Evaluate ability and availability of designated caregiver(s) to provide patient support. Coordinate and implement interventions using evidence based guidelines. Recommend additional services to PCP as determined in the case management plan. Conduct ongoing assessment of progress against original goals. Continuously update needed services. Maintain ongoing communication with patient/family and care team. Acts as an advocate for patient care needs. Documents all responses of patient to case management interventions.
  • Collaborates with other health care professionals regarding the plan of care, variances in plan implementation, achieved outcomes or expected outcomes. Monitor and evaluate short and long term patient responses to therapeutic interventions and analyze patterns of variance from clinical information and outcomes. Recommend alternative settings for care based on health care needs and appropriate utilization of health care resources. Document interventions and interactions with patients or caregivers according to KFHPW and Care Management policy and procedure. Participate in the measurement of the effectiveness of the case management program.
  • Directs and guides the plan of care to result in a seamless continuum of care. Facilitates as needed, referrals for home health care, long term care, hospice, and other care facilities or services. Participation in care conferences to provide problem solving for patients with complex care needs (limited basis). Collects needed data needed to evaluate the effects of care coordination on quality outcomes, fiscal parameters, patient satisfaction and systems improvement. Understands and utilizes health plan requirements and patient benefits in making care management decisions. Assists patient to understand and comply with their medical treatment plan. Supports patient education and activation through referral to specific chronic illness classes, group visits or community resources.

Basic Qualifications:
Experience

  • Minimum three (3) years of recent RN medical/surgical/ambulatory clinical experience required.
  • Minimum two (2) years of RN experience in ambulatory case management, care coordination or disease management.
Education

  • Bachelors degree
License, Certification, Registration
  • Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire
  • Basic Life Support required at hire
  • Case Manager Certificate within 36 months of hire
Additional Requirements:

  • Effective, independent nursing judgment and skills, and use of evidence based clinical decision making criteria.
  • Knowledge in management of chronic disease process, nursing process and collaborative care planning.
  • Demonstrated skill and experience in effectively collaborating with care team members.
Preferred Qualifications:

  • Minimum two (2) years of RN experience in utilization review, ambulatory case management, care coordination or disease management.
  • Bachelors of science in nursing.

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