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Utilization Review Manager Jobs in Seattle, WA (NOW HIRING)

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

... processing Utilization Management (UM) organization determinations for services requiring ... Reviews completed denial letters for accuracy and adherence to compliance deadlines. Edits and ...

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Utilization Review Manager information

See Seattle, WA salary details

$44.4K

$103.6K

$190.6K

How much do utilization review manager jobs pay per year?

As of Jul 28, 2026, the average yearly pay for utilization review manager in Seattle, WA is $103,572.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,700.00 and $124,600.00 per year, depending on experience, location, and employer.

What are some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What are the key skills and qualifications needed to thrive as a Utilization Review Manager, and why are they important?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a Utilization Review Manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
What are the most commonly searched types of Utilization Review jobs in Seattle, WA? The most popular types of Utilization Review jobs in Seattle, WA are:
What are popular job titles related to Utilization Review Manager jobs in Seattle, WA? For Utilization Review Manager jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Seattle, WA look for? The top searched job categories for Utilization Review Manager jobs in Seattle, WA are:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Seattle, WA as of July 2026, with employment types broken down into 2% Internship, 94% Full Time, 2% Part Time, and 2% Contract. Highlights an 83% In-person, 4% Hybrid, and 13% Remote job distribution, with an average salary of $103,632 per year, or $49.8 per hour.

RN - Care Manager Utilization Review

MLee Medical Employment

Vashon, WA • On-site

Other

Medical, Dental, Vision, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Join a dynamic healthcare team in the Pacific Northwest as a Registered Nurse Care Manager specializing in Utilization Review. This role involves coordinating care and managing the utilization of services for patients in acute and post-acute skilled care settings. You will collaborate closely with interdisciplinary teams both inside and outside the organization to enhance patient outcomes and ensure cost-effective care.
Job Summary
As a vital member of the care team, you will continuously assess the appropriateness and timeliness of care levels, ensuring resources are used efficiently. Your daily activities include rounding with patients, conducting assessments, and facilitating smooth transitions from hospital to home or other care facilities. You will also identify and resolve discharge barriers, provide clear documentation, and support peer-to-peer reviews for concurrent denials.
Education and Experience

  • Minimum of 2 years of Registered Nursing experience in acute care or care management/utilization review.
  • Current RN license valid in the region or multistate license.
  • BLS certification is required.
  • Bachelor's degree in Nursing and Care Manager Certification are preferred.
Skills and Abilities
  • Strong organizational and prioritization skills.
  • Excellent written and verbal communication tailored to diverse audiences.
  • Proficiency with technology and software, including intermediate to advanced Microsoft Office skills.
  • Ability to maintain confidentiality and accurate documentation.
  • Demonstrated teamwork, collaboration, and customer service skills in fast-paced environments.
  • Independent problem-solving and sound judgment to complete tasks effectively.

Work Environment and Benefits
This full-time exempt position offers a supportive work environment with opportunities for professional growth. Benefits include competitive compensation, comprehensive medical, dental, and vision coverage, retirement plans with employer contributions, tuition reimbursement, employee wellness programs, and more. The location provides access to numerous outdoor recreational activities such as hiking, kayaking, fishing, and cultural experiences in the Pacific Northwest region.

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