Top 35 Utilization review Jobs in Everett, Wa

Care Review Clinician (RN)
Molina Healthcare —Bothell, WA
- $26.41 - $59.21 an hour
- Full-time
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
1d
Clinical Utilization Management Coordinator (UM) $5k Sign-On
Smokey Point Behavioral Hospital —Marysville, WA
- $34 - $38 an hour
- Full-time
- Nursing
- Addiction Medicine
- Hospital
- Free parking
- Paid holidays
Quick Apply
Care Advisor
Family Advocacy Services —Arlington, WA
- $25.55 - $52.00 an hour
- Contract
- Mid-level
- Social Work
- Medical terminology
Quick Apply
4d
Care Manager RN - 0.6 FTE- Day
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Part-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Board-Certified Pain Management Specialist
Dane Street, LLC —Everett, WA
- Contract
- BC/BE
- Mid-level
- Analysis skills
Quick Apply
Financial Counselor
Smokey Point Behavioral Hospital —Marysville, WA
- $20 - $25 an hour
- Overtime
- Addiction Medicine
- High school diploma or GED
- Discharge planning
- Free parking
- Paid holidays
Quick Apply
9d
Care Manager RN - 1.0 FTE Day
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Admissions Director.
820 NW 95th Street Operations LLC —Seattle, WA
- $72,800 - $82,784 a year
- Skilled nursing facility
- Marketing
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Clinical Liaision (Paramedic / Allied Health Professional)
myLaurel —Everett, WA
- $100,000 - $105,000 a year
- Full-time
- Acute care
- Hospital
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Care Manager RN ED - Night
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Business Office Manager - Skilled Nursing Facility / Shoreline, WA
Avamere Skilled Advisors, LLC —Shoreline, WA
- $80,000 - $90,000 a year
- Full-time
- Microsoft Excel
- Skilled nursing facility
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
4d
Advanced Practice Provider
Community Health Center of Snohomish County —Everett, WA
- $117,945.14 - $155,445.14 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- Paid holidays
Quick Apply
Board Certified Otolaryngologist (M.D, D.O.) Washington L&I IME
Dane Street, LLC —Everett, WA
- Contract
- Medicine
- Clinic
- Senior level
Quick Apply
Manager, Transitions of Care
Overlake Medical Center and Clinics —Bellevue, WA
- $111,155 - $177,840 a year
- Day shift
- Nursing
- RN License
- Hospital
- Tuition reimbursement
- Employee assistance program
10d
Director of Inpatient & Health Care Services
Compass Health —Everett, WA
- $185,062.91 - $283,162.88 a year
- Full-time
- Nursing
- RN License
- Computer literacy
- 403(b) matching
- Mileage reimbursement
Quick Apply
12d
Board Certified Neurologist (M.D, D.O.) Washington L&I IME
Dane Street, LLC —Everett, WA
- Contract
- Medicine
- Clinic
- Neurology
Quick Apply
Home Health Clinical Manager
Centerwell —Seattle, WA
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
1d
Clinical Director - Dental
Community Health Center of Snohomish County —Everett, WA
- $160,133.14 - $173,858.83 a year
- Dental office
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- Paid holidays
Quick Apply
Physical Therapist
Community Health Center of Snohomish County —Everett, WA
- $86,108 - $117,111 a year
- Monday to Friday
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- 403(b) matching
- Paid holidays
Quick Apply
Physician - Family or Internal Medicine
Community Health Center of Snohomish County —Everett, WA
- $147,493.99 - $255,337.59 a year
- Full-time
- Medicine
- Microsoft Excel
- Microsoft Outlook
- 403(b) matching
- Paid holidays
Quick Apply

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utilization review jobs near everett, wa

Care Review Clinician (RN)

Molina Healthcare -
Bothell, WA

Apply Now

Job Details

Full-time
$26.41 - $59.21 an hour
1 day ago

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Productivity software

Full Job Description

JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/VPay Range: $26.41 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

utilization review jobs in everett, wa

Care Review Clinician (RN)

Clinical Utilization Management Coordinator (UM) $5k Sign-On

Care Advisor

Care Manager RN - 0.6 FTE- Day

Board-Certified Pain Management Specialist

Financial Counselor

Care Manager RN - 1.0 FTE Day

Admissions Director.

Clinical Liaision (Paramedic / Allied Health Professional)

Care Manager RN ED - Night

Business Office Manager - Skilled Nursing Facility / Shoreline, WA

Advanced Practice Provider

Board Certified Otolaryngologist (M.D, D.O.) Washington L&I IME

Manager, Transitions of Care

Director of Inpatient & Health Care Services

Board Certified Neurologist (M.D, D.O.) Washington L&I IME

Home Health Clinical Manager

Clinical Director - Dental

Physical Therapist

Physician - Family or Internal Medicine

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