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Utilization Case Manager Jobs in Spokane, WA (NOW HIRING)

Premera Blue Cross

Case Manager, RN

Spokane, WA · On-site

Our Case Managers are a compassionate team of clinicians who support members through a whole-person ... Engage members who are facing medical utilization disorders and build a relationship that will ...

Vivian Health

RN Care Manager in Spokane, WA

Spokane, WA · On-site

$54 - $59/hr

Prior case management, utilization review, and discharge planning experience preferred * Certified Case Manager (CCM) or Board Certification in Nursing Case Management (RN BC) preferred Specific Job ...

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How much do utilization case manager jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for utilization case manager in Spokane, WA is $36.89, according to ZipRecruiter salary data. Most workers in this role earn between $29.90 and $38.89 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 are popular job titles related to Utilization Case Manager jobs in Spokane, WA?

For Utilization Case Manager jobs in Spokane, WA, the most frequently searched job titles are:

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

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

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

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

Utilization Case Manager jobs near you

Case Manager, RN

Premera Blue Cross

Spokane, WA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 3 days ago

Premera Blue Cross rating

8.0

Company rating: 8.0 out of 10

Based on 20 frontline employees who took The Breakroom Quiz

167th of 311 rated insurance

Job description

Workforce Classification:
Telecommuter
Join Our Team: Do Meaningful Work and Improve People's Lives
Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. It's this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.
Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.
Our Case Managers are a compassionate team of clinicians who support members through a whole-person care model. We partner with individuals to understand their unique medical health needs, remove barriers, and empower meaningful progress toward emotional well-being and healthier daily living.
Who we serve:
Premera Blue Cross, a nationally recognized leader in the practice of integrated case management, is looking to expand our growing team of Case Managers. Our comprehensive, whole-person health assessment helps to identify member actionable barriers and develop obtainable goals that will eventually lead to self-care. In the interim, case managers employ an integrated case management approach that recognizes making lifestyle changes is not simple and meets members where they are. We also monitor progress toward goals and facilitate the coordination of providers as needed. Our market-differentiated approach has helped thousands of members make meaningful improvements to their daily habits, health, and overall well-being.
What you will get in this role:
  • The opportunity to help members in a meaningful and impactful way. We know that helping people is important to you.
  • The opportunity to learn and grow. You will be working with folks who literally wrote the book on integrated case management.
  • The opportunity to have an impact. Your work improves the lives of our members and enables us to operate more impactfully.
  • The opportunity to thrive in a career. We offer a supportive and safe environment where clinicians can work to the top of their licensure.
  • The opportunity to take pride. We know your work is important just as you do.

What you will do:
  • Engage members who are facing medical utilization disorders and build a relationship that will support open and constructive dialog on sensitive topics.
  • Conduct initial holistic health assessments that help build an understanding of a member's specific situation and needs and identify any social determinants of health (SDOH) and cultural influences that may impact potential lifestyle changes.
  • Create a space where a case manager and member can collaborate, along with relevant caregivers and providers, to develop a member-centric case management plan that sets goals, addresses potential barriers, and leads to improved health outcomes.
  • Monitor, evaluate, and update the effectiveness of the member's case management plan to ensure progress toward goals is being made and that current goals remain pertinent.
  • Facilitate communication and coordination among the health care team to maximize delivery of appropriate care.
  • Provide interventions focused on removing barriers, promoting positive behavior change using motivational interviewing techniques, and stabilizing the members' natural support systems by ensuring that caregiver needs are identified and being met.
  • Maintain concise, accurate, and timely documentation that meets accreditation, contractual, and legal requirements.

What you will bring:
Required:
  • Active WA State or Compact RN or ARNP license that allows you to conduct an assessment independently.
    • 3 years' post licensure direct care experience.
  • 1 year of post-licensure case management experience involving care coordination, care planning, discharge planning, or management of patient care over time

Preferred:
  • Certified Case Manager (CCM) certification. If applicants do not have their CCM certification at hire, then they are required to obtain within 24 months of hire.
  • Bachelor's or Master's degree
  • 4 or more years direct care experience across multiple patient populations, conditions, or care settings
  • Motivational interviewing experience
  • Chronic Condition Certifications (Asthma, Cardiology, Diabetes, High Risk Maternity, Oncology, Pediatrics)
  • Integrated Case Management certificate (ICM)
  • Chemical Dependency Professional (CDP) certification
  • LEAN training

Conditional Requirements:
  • Individuals residing outside Washington must have or obtain the appropriate Washington State license (apply within 10 days of acceptance)
  • Internet access through any Internet Service Provider (ISP) with a minimum connection speed of 75 Mbps (megabits per second) download speed

Training and Perks:
  • Paid licensure renewal
  • Reimbursement for CCM exam fees and renewal
  • Premera provides extensive training including initial and ongoing motivational interviewing skill development.
  • Support in earning your Chronic Care Professional (CCP) certificate, Integrated Case Manager (ICM) certificate, as well as your Certified Case Manager (CCM) credential.
  • Since 2012, Premera has been a NCQA accredited program earning full credit for our case management program. All our clinicians receive documentation, assessment, and intervention skill training to ensure they are practicing at the highest professional skill level.
  • Clinicians and managers also employ LEAN methodology that supports their active involvement in process improvement activities.
  • Paid membership in the National Case Management Society of America (CMSA) and the local state chapters

Work Location and Schedule:
  • This position is classified as a telecommuter.
  • Training Schedule: Your training schedule for the first six weeks of hire will be Monday through Friday, between 8 am and 5 pm PT (Pacific Time)
  • Ongoing Schedule: You will be working a 40-hour weekly schedule that includes 5 hours that will provide coverage for extended hours (Monday through Friday between 5 and 7 pm or Saturday between 9 am and 2 pm. Note: all times are Pacific)
  • Please note: Schedules are subject to periodic change due to member coverage requirements.

Premera total rewards
Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:
  • Medical, vision, and dental coverage with low employee premiums.
  • Voluntary benefit offerings, including pet insurance for paw parents.
  • Life and disability insurance.
  • Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
  • Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
  • Generous paid time off to reenergize.
  • Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
  • Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
  • Commuter perks make your trip to work less impactful on the environment and your wallet.
  • Free convenient on-site parking.
  • Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
  • Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
  • Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
  • Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience.
The salary range for this role is posted below; we generally target up to and around the midpoint of the range.
National Salary Range:
$80,200.00 - $125,600.00
National Plus Salary Range:
$84,200.00 - $143,100.00
*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.
We're happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We're committed to creating an environment where all employees are celebrated for their unique skills and contributions.

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