RN Care Manager | Utilization Review Specialist

Join a dedicated healthcare team in the Pacific Northwest region as an RN Care Manager specializing in utilization review. This role involves coordinating care and managing service utilization for patients in acute and post-acute skilled settings. You will collaborate closely with interdisciplinary teams both inside and outside the organization to enhance patient care and achieve optimal clinical and financial outcomes. Job Duties and Responsibilities Continuously evaluate the appropriateness and timeliness of care levels, ensuring efficient use of resources by assessing patient needs and available services. Work alongside interdisciplinary teams to deliver cost-effective, patient-centered care that respects individual preferences and values. Participate in daily rounds and patient assessments to support decisions regarding ongoing acute hospitalization and post-acute care needs. Develop and implement goal-oriented, age-appropriate care plans. Coordinate care from admission through discharge, facilitating safe transitions to home or other facilities with necessary services. Identify and address discharge barriers promptly. Educate patients and families on third-party payer guidelines to arrange suitable referrals. Maintain clear, timely, and thorough documentation in accordance with departmental standards. Support coordination efforts for concurrent denials, including peer-to-peer discussions with nurses or providers. Adapt to changes in the work environment and lead others through transitions. Build and sustain professional relationships, fostering trust and credibility. Create positive experiences for patients, colleagues, and customers. Engage in ongoing professional development and skills training. Promote teamwork and support new team members to cultivate a positive work atmosphere. Maintain open, honest communication while protecting privacy and confidentiality. Contribute thoughtfully to strategic planning and participate in departmental initiatives. Complete special projects as assigned. Education and Experience Minimum of 2 years of registered nursing experience in acute care hospitals and/or care management or utilization review in any healthcare setting. Current RN license valid in Washington or multistate licensure. Current Basic Life Support (BLS) certification. Bachelor's degree in Nursing and Care Manager Certification are preferred. Skills and Abilities Strong organizational skills with the ability to prioritize and adjust tasks as needed. Excellent written and verbal communication skills tailored to diverse audiences. Proficiency with technology and software, including intermediate to advanced Microsoft Office applications. Ability to handle confidential information with discretion. Demonstrated teamwork, collaboration, and customer service skills. Capacity to remain composed and professional in fast-paced, high-stress environments. Independent problem-solving, sound judgment, and effective time management. This position offers a supportive environment with comprehensive benefits designed to promote well-being, professional growth, and financial security. Enjoy access to wellness programs, fitness classes, and a variety of employee assistance resources. The role is based in a scenic region known for its outdoor recreational opportunities including hiking, kayaking, nature viewing, and fishing, providing a balanced lifestyle for healthcare professionals.

Created: 2026-03-06