Req #: 247314 Department: UW MEDICAL CENTER - UTILIZATION MANAGEMENT Job Location: Remote/Hybrid Posting Date: 07/09/2025 Closing Info: Open Until Filled Salary: 50% of $9,000 - $11,750 per month UW Medical Center has an outstanding opportunity for an experienced Utilization Review Nurse to join our team. WORK SCHEDULE Fully remote / work from home Must be available to work day shifts during Pacific Standard Time 20 hours/weekend (two - 10 hour shifts Saturday and Sunday) POSITION HIGHLIGHTS Ensures the delivery of optimal care for our patients while promoting fiscal responsibility Maintains efficient, cost effective care management processes by determining the medical necessity and financial liability for all hospitalized patients Plays a key role ensuring compliance with regulatory requirements, policies, and procedures PRIMARY JOB RESPONSIBILITIES Identify clinical indications for admission Track hospital events and course in order to justify patient admission and continued stay for payer reimbursement Communicate with third party payers regarding patient clinical progress Assess and communicate potential reasons for payer denials and attempts to resolve the denial with the team at the time of identification Participate in activities of identifying high risk vulnerabilities to the organization Use critical thought processes and decision making in monitoring the continuum of care Support work at both UW Medical Center – Northwest and UW Medical Center - Montlake REQUIREMENTS 3 years of work experience in utilization management 5 years of nursing work experience in an acute care med-surg setting Bachelor's Degree in Nursing, or equivalent education and training Active licensure to practice as a Registered Nurse in Washington State by start date Knowledge of medical screening criteria Computer skills to appropriately navigate electronic charting and referral systems DESIRED Case Management certification preferred Previous experience with Xsolis software and MCG criteria preferred ABOUT UW MEDICINE – WHERE YOUR IMPACT GOES FURTHER UW Medicine is Washington’s only health system that includes a top-rated medical school and an internationally recognized research center. UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals. All across UW Medicine, our employees collaborate to perform the highest quality work with integrity and compassion and to create a respectful, welcoming environment where every patient, family, student and colleague is valued and honored. Nearly 29,000 healthcare professionals, researchers, and educators work in the UW Medicine family of organizations that includes: Harborview Medical Center, UW Medical Center - Montlake, UW Medical Center - Northwest, Valley Medical Center, UW Medicine Primary Care, UW Physicians, UW School of Medicine, and Airlift Northwest. Become part of our team. Join our mission to make life healthier for everyone in our community. Committed to attracting and retaining a diverse staff, the University of Washington will honor your experiences, perspectives and unique identity. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable and welcoming. The University of Washington is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, or genetic information. Apply To this Job