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Utilization Management Coordinator Jobs in Rochester, WA

A24Group

Director Care Management FT

Olympia, WA · On-site

$150K - $220K/yr

Bachelor's Degree in Nursing (Master's preferred). * 2+ years as RN in acute care. * 3+ years managing care coordination (utilization review knowledge preferred). * Proven independent leadership and ...

UnitedHealthcare

Registered Nurse- Home Health

Centralia, WA · On-site

$43.53 - $65.29/hr

... coordination with other health care team members * Completes comprehensive assessments (OASIS ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse- Home Health

Olympia, WA · On-site

$45.71 - $68.56/hr

... coordination with other health care team members * Completes comprehensive assessments (OASIS ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

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Utilization Management Coordinator information

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How much do utilization management coordinator jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization management coordinator in Rochester, WA is $30.92, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $36.15 per hour, depending on experience, location, and employer.

What does a utilization management coordinator do?

A Utilization Management Coordinator is responsible for reviewing and assessing healthcare services to ensure that patients receive appropriate care while managing costs for healthcare providers or insurance companies. They evaluate medical records, coordinate with healthcare professionals, and help determine if certain treatments or procedures are medically necessary according to established guidelines. Their goal is to optimize the use of healthcare resources, prevent unnecessary treatments, and support quality patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization management coordinator?

To thrive as a Utilization Management Coordinator, you need a background in healthcare or nursing, knowledge of medical terminology, and experience in case management or utilization review, often supported by a relevant degree or certification (such as RN or LPN). Familiarity with utilization management software, electronic health records (EHRs), and insurance authorization platforms is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this role. These capabilities ensure accurate review of medical cases, compliance with regulations, and efficient coordination between providers, payers, and patients.

How does a utilization management coordinator typically collaborate with clinical staff and insurance providers?

A Utilization Management Coordinator serves as a vital link between healthcare providers, clinical staff, and insurance companies. They regularly communicate with physicians and nurses to gather clinical information, review treatment plans, and ensure that proposed services meet medical necessity criteria. Coordinators also interact with insurance providers to obtain pre-authorizations, clarify coverage policies, and appeal denied claims when appropriate. Effective collaboration and strong communication skills are essential, as the role requires balancing the needs of patients, providers, and payers while ensuring timely and cost-effective care.

What degree do you need for utilization management coordinator?

A utilization management coordinator typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.

What cities near Rochester, WA are hiring for Utilization Management Coordinator jobs?

Cities near Rochester, WA with the most Utilization Management Coordinator job openings:

Utilization Management Coordinator jobs near you
Infographic showing various Utilization Management Coordinator job openings in Rochester, WA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $64,316 per year, or $30.9 per hour.

Behavioral Health Utilization Management Clinician I (RN)

CHPW

Olympia, WA • On-site

$35.92 - $55.67/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 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 Utilization Management Clinician performs utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements high quality, cost-effective alternatives when appropriate to the patient's condition. Supports physician decision-making, working collaboratively with all members of the health care team, the patient, the patient's family, co-workers, and internal and external customers to achieve optimal patient outcomes. Ensures members have timely access to care and supports during transitions between levels of care. Understands and effectively communicates requirements and follows Community Health Plan of Washington (CHPW) policies and procedures.
To be successful in this role, you:
  • Have a bachelor's degree in a relevant field or an equivalent combination of education and highly relevant experience.
  • Have a current, unrestricted license as an RN or LPN.
  • Have at least two years clinical experience in either a physical health or behavioral health setting.
  • Have previous experience in Utilization Management and Managed Care, preferred.

Essential functions and Roles and Responsibilities:
  • This role does require travel to local hospitals within Pierce and Thurston Counties.
  • Conduct review of hospital notification or prior authorization care requests against established clinical guidelines and health plan policies.
  • Collaborate with facilities to perform discharge planning.
  • Provide coordination support to members transitioning between care settings or returning home from a hospitalization. Identifies member needs and provides support to ensure necessary services are available during the transition period.
  • Collaborates with providers, office staff, and Care Coordination team to assure coordination of care in a timely manner according to contractual and regulatory timeframes.
  • Identifies, coordinates, and ensures high quality care and appropriate care by focusing on supporting access to care and services across the continuum of care in accordance with the patient's medical needs.
  • Identify potentially unnecessary services and/or delivery settings and recommends appropriate alternatives.
  • Identifies and determines medical necessity of out of network (OON) requests for services.
  • Assures referrals are complete and enrollment/eligibility benefits verified, prior to authorizing care.
  • Delivers timely written notification to patient or family members and communicates with members of the health care team.
  • Prepare cases that do not meet medical necessity or criteria for medical director review.
  • Communicate effectively with medical director regarding identified variances within the case against criteria utilized for medical review.
  • Regularly communicates with the UM Manager, Medical Director, physician advisor/reviewer and primary care physician for support, problem resolution and notification of decertification and appeals.
  • Using established screening tools, identify candidates and recommend enrollment into care management and disease management programs.
  • Identify quality of care issues and report for investigation per CHPW's policy.
  • Participates as part of the care management team; works collaboratively with all department staff.
  • 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:
  • Ability to effectively manage and maintain quality standards for high volume of authorization.
  • Ability to work independently.
  • Effective written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
  • Knowledge in criteria set, including MCG, InterQual, ASAM, and LOCUS preferred.
  • Ability to multi-task and deal with complex assignments with competing priorities on a frequent basis.
  • Perform all functions of the job with accuracy, attention to detail and within established timeframes.
  • Effective analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
  • Experience in care management workflow systems.
  • Flexibility and willingness to work in a matrix-management environment.
  • Demonstrated organizational, time management, and project management skills.
  • Demonstrated proficiency and experience with Microsoft Office products.
  • Ability to present in a group setting.
  • Willingness to be part of a collaborative and dynamic clinical development team.
  • Collaborate with others in a respectful manner and ability to maintain confidentiality.

Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
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 eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
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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