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Utilization Review Rn Jobs in Bothell, WA (NOW HIRING)

CHPW

Utilization Management Clinician I

Seattle, WA · On-site +1

$35.92 - $55.67/hr

Have a current, unrestricted license as an RN or LPN. * Have at least two years clinical experience ... Conduct review of hospital notification or prior authorization care requests against established ...

EverCare Recruiting

Care Manager RN ED

Seattle, WA

Washington Registered Nurse License upon hire. * 2 years - Acute care experience in a Medical ... utilization review in any setting or successful completion of TIPS program or Case Management ...

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Utilization Review Rn information

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$23

$47

$77

How much do utilization review rn jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for utilization review rn in Bothell, WA is $47.27, according to ZipRecruiter salary data. Most workers in this role earn between $37.36 and $54.28 per hour, depending on experience, location, and employer.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Bothell, WA? The most popular types of Utilization Review Rn jobs in Bothell, WA are:
What are popular job titles related to Utilization Review Rn jobs in Bothell, WA? For Utilization Review Rn jobs in Bothell, WA, the most frequently searched job titles are:
What cities near Bothell, WA are hiring for Utilization Review Rn jobs? Cities near Bothell, WA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Bothell, WA as of June 2026, with employment types broken down into 1% As Needed, 59% Full Time, 8% Part Time, 1% Temporary, 30% Contract, and 1% Nights. Highlights an 88% Physical, 5% Hybrid, and 7% Remote job distribution, with an average salary of $98,314 per year, or $47.3 per hour.

Utilization Review Coordinator

Guidelight Health

Seattle, WA • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 7 days ago

Job description

Guidelight Health is a cutting-edge behavioral healthcare company dedicated to transforming lives through high-quality PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program) services. As a newly launched organization, we are on a mission to redefine the behavioral health industry by delivering exceptional care, utilizing state-of-the-art facilities, and prioritizing the well-being of those we serve. At Guidelight Health, we are building a team of passionate, forward-thinking professionals who are eager to be part of this exciting journey to reshape mental health care. Join us in making a lasting impact!

Title: Utilization Review Coordinator

Reports to: Director of Revenue Cycle Management

Department/Location: Remote, but only considering candidates in PST.

FLSA Status: Exempt

Travel Requirement: None

Summary:

Reporting directly to the Director of Revenue Cycle Management, this team member plays an essential role in helping clients access and continue the care they need. They will be responsible for handling pre-certifications, authorizations, retro-authorizations, appeals, medical records requests, and chart auditing duties that support accurate reporting of each client's clinical level of care, program participation, and treatment days utilized. As a subject matter expert on payor requirements and expectations, particularly across the WA and CA markets, this individual will partner closely with clinical and revenue cycle teams to remove administrative barriers, optimize utilization review outcomes, and support Guidelight's mission of delivering accessible, high-quality behavioral healthcare.

Responsibilities:

  • Utilization Review on Behalf of the Clinics:
    • Prescreen referrals to project/anticipate authorizations. Provide recommendations regarding level of care/services and treatment planning.
    • Conduct live reviews with payors and level of care chart reviews, conceptualizing the clinical presentation and care needs and applying medical necessity guidelines and /or LOCUS to compel authorization.
    • Clinically negotiate authorization outcomes with the payor, collaborating in advance with the primary treating clinicians.
    • Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling. Provide guidance and training to clinicians on completing P2P reviews.
    • Establish internal authorization or denial determinations for No Authorization Required (NAR) requests.
    • Establish post denial appeal response recommendations.
    • Obtain portal access to any utilization review portals for an efficient and scalable process.
  • Interdepartmental Relations and Communication:
    • Coordinate with the clinical team on requests with clinically weaker presentations.
    • Coordinate all concurrent insurance reviews with clinicians and medical team.
    • Provide guidance on specific interventions or areas on which to focus to result in maximum authorized days.
    • Provide ongoing feedback and recommendations for improvement to meet payor medical necessity guidelines.
    • Attend and participate in daily huddles/weekly rounds as the payor expert to ensure appropriate authorization outcomes and provide ongoing education regarding payor requirements.
    • Communicate with relevant parties at the facility and in RCM about any issues with coverage or denials, facilitating client notifications as needed.
    • Partner with intake, utilization review, and finance for best practices in overarching company goals related to RCM.
    • Timely completion of the Denial Notification process.
  • Accurate Data Entry:
    • Document deficiencies for identification on the daily reporting
    • Timely documentation of authorization in KIPU/Avea
    • Upload authorization letters to KIPU/Avea UR module.
  • Clinical Auditing:
    • Notify the primary therapist of any missing documentation or delinquent services
    • Review medical records for quality clinical documentation and compliance with licensing, accrediting, and payor requirements
    • Running daily reports to ensure that all information needed for timely review has been entered into the EMR and communicating with the clinic team members to correct or update any missing or incorrect documentation.
  • Policy Compliance:
    • Ensuring compliance with legal, regulatory, and policy requirements.
  • Process Improvement:
    • Identifying Clinical problems and proposing innovative solutions.
  • Additional job duties as assigned.

Qualifications:

  • Bachelor's degree in Social Work, Nursing, or any related field.
  • Must be based in PST, with an understanding of the west coast Payer landscape, specifically CA or WA.
  • 2-3+ years of UR experience in behavioral health, ideally across PHP or IOP levels of care.
  • Knowledge of medical necessity criteria, payer authorization processes, documentation standards, and regulatory requirements.
  • Proficient in MS Office applications and ability to learn department and job-specific software systems (e.g., applicable practice management and EMR systems)
  • Strong organizational, communication, analytical, and problem-solving skills with exceptional attention to detail.
Pay Range
$70,000—$80,000 USD

Benefits & Perks

At Guidelight, we value a work-life integration culture. This approach allows our teammates to focus on what matters most to them, while also caring for our clients and fellow teammates. We have found that this promotes a sustainable and successful culture, and we offer the following benefits to our teammates to demonstrate this commitment to each other. 

As a Guidelight teammate, working 32+ hours per week, you'll enjoy a comprehensive benefits package, including:

  • Health & Wellness: Medical, dental, vision, HealthJoy unlimited therapy, UHC wellness program, HSA/FSA options, and pet insurance.
  • Time Off: Responsible PTO, in lieu of a traditional accrual-based policy, which allows full-time and part-time employees to take the time they need, when they need it, while ensuring continuity of care and team collaboration
  • 401(k): With company match.
  • Licensing: All licensing fees covered, including opportunities for cross-licensure when applicable.
  • Professional Development: Annual stipend for tuition reimbursement, ongoing education, or CEUs.
  • Clinical Supervision & Growth: Pre-licensed clinicians receive structured clinical supervision toward licensure, and all clinicians benefit from best-in-class supervision grounded in our state-of-the-art PHP/IOP curriculum.