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Utilization Reviewer Jobs in Seattle, WA (NOW HIRING)

CHPW

Utilization Management Coordinator I

Seattle, WA · On-site +1

$21 - $28.98/hr

The level I UM Coordinator is responsible for administrative functions in processing Utilization ... Reviews completed denial letters for accuracy and adherence to compliance deadlines. Edits and ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Seattle, WA

Utilization Reviewer information

See Seattle, WA salary details

$35.3K

$43.2K

$50.1K

How much do utilization reviewer jobs pay per year?

As of Aug 1, 2026, the average yearly pay for utilization reviewer in Seattle, WA is $43,235.00, according to ZipRecruiter salary data. Most workers in this role earn between $38,700.00 and $47,800.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a Utilization Reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and knowledge of medical coding and documentation are important; some employers may also require certification such as the Certified Professional Medical Auditor (CPMA).

Is utilization review a stressful job?

Utilization reviewers often work in a fast-paced environment where accuracy and attention to detail are essential, which can contribute to job stress. The role may involve managing high caseloads and strict deadlines, but stress levels vary depending on the work setting and individual coping strategies.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

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

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

Is utilization review work from home?

Utilization reviewer jobs can often be performed remotely, especially in organizations that utilize electronic health records and telecommunication tools. Many employers offer work-from-home options for this role, which typically requires strong analytical skills, knowledge of healthcare policies, and certification in case management or utilization review. However, some positions may require on-site presence depending on company policies and regulatory requirements.

What jobs pay 4000 a week without a degree?

Utilization reviewers typically do not earn $4,000 a week without a degree; this role usually requires healthcare or insurance industry experience and certifications. High-paying jobs that can reach this level without a degree often include sales, real estate, or skilled trades like plumbing or electrical work, which rely on experience and skills rather than formal education.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Seattle, WA? For Utilization Reviewer jobs in Seattle, WA, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Seattle, WA look for? The top searched job categories for Utilization Reviewer jobs in Seattle, WA are:
What cities near Seattle, WA are hiring for Utilization Reviewer jobs? Cities near Seattle, WA with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Seattle, WA as of July 2026, with employment types broken down into 84% Full Time, 9% Part Time, 3% Contract, and 4% Nights. Highlights an 60% Physical, 2% Hybrid, and 38% Remote job distribution, with an average salary of $43,235 per year, or $20.8 per hour.

Utilization Review Nurse

Virginia Mason Medical Center

Seattle, WA

$52.03 - $101.24/hr

Part-time

Posted 5 days ago

Job description


Job Summary and Responsibilities

As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and optimal patient outcomes. You will leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay.
Every day you will perform meticulous clinical assessments, identify and coordinate cost-effective alternatives, and proactively support provider decision-making. You will collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically, ensuring compliance with payer guidelines and regulatory standards.
To be successful in this role you will have strong analytical skills, persuasive communication, and a steadfast commitment to patient advocacy.  Fiscal stewardship is crucial for navigating complex clinical and financial landscapes, ensuring appropriate resource utilization.

Job Requirements

Required

  • Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
  • Active Washington State Registered Nurse License.
  • Experience in utilization review.
  • Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
  • An understanding of variable payor rules and regulations is also required.

Preferred

  • Knowledge of core insurance coverage guidelines and financial principles.
  • Acute care nursing experience.
Where You'll Work

Virginia Mason Franciscan Health brings together two award winning health systems in Washington state - CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers. At Virginia Mason Franciscan Health you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.

Qualifications:

Required

  • Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
  • Active Washington State Registered Nurse License.
  • Experience in utilization review.
  • Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
  • An understanding of variable payor rules and regulations is also required.

Preferred

  • Knowledge of core insurance coverage guidelines and financial principles.
  • Acute care nursing experience.
Employment Type: Part Time

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