Utilization Review ManagerAvalon Care Center Federal Way | Federal Way, WA$40.00 - $45.00/hourFull-TimeAt Avalon Care Center Federal Way, you'll play a critical role in supporting quality resident care, successful care transitions, and reimbursement integrity. As the Utilization Review Manager, you'll work closely with interdisciplinary teams, payers, physicians, and referral sources to ensure residents receive the appropriate level of care while supporting operational and financial success.
This is an excellent opportunity for an experienced utilization management professional who enjoys problem-solving, relationship building, and navigating complex healthcare systems.
Competitive pay
Comprehensive benefits package
Meaningful work that impacts resident outcomes
Opportunity to collaborate with physicians, therapists, and care teams
Career growth and professional development opportunities
Key role in admissions, authorizations, and care transitions
Stable healthcare environment
Supportive and collaborative leadership team
Full-Time Benefits- 401(k)
- Medical, Dental & Vision
- Flexible Spending Accounts (FSA)
- Life Insurance
- Short & Long-Term Disability
- Critical Illness & Accident Coverage
- Legal Benefits
- Identity Theft Protection
- Auto & Home Insurance Discounts
What You'll Do- Manage pre-admission authorizations, insurance verification, Single Case Agreements (SCAs), and Letters of Agreement (LOAs)
- Conduct utilization review and level-of-care determinations to support appropriate admissions and continued stays
- Perform concurrent reviews and obtain clinical updates from physicians, therapy teams, and interdisciplinary team members
- Communicate resident progress, clinical status, and discharge plans to payers in a timely and accurate manner
- Negotiate appropriate levels of care and reimbursement arrangements within payer contract requirements
- Serve as a liaison between payers, discharge planners, physicians, facility leadership, and interdisciplinary care teams
- Support care transitions and discharge planning to promote positive resident outcomes
- Monitor authorization and documentation requirements to support reimbursement accuracy and revenue integrity
- Maintain accurate case management documentation, reports, and payer communications
- Support census development efforts and build relationships with referral sources and community partners
What You'll Need- Associate degree in a health or human services field preferred
- Certified Case Manager (CCM) credential preferred
- Previous utilization management, case management, authorizations, or healthcare reimbursement experience preferred
- Experience working with managed care organizations, Medicare Advantage plans, commercial payers, and third-party administrators
- Knowledge of utilization review, level-of-care determinations, concurrent review, and authorization processes
- Experience with Single Case Agreements (SCAs) and Letters of Agreement (LOAs) preferred
- Skilled nursing, post-acute care, long-term care, or healthcare experience preferred
- Nursing background strongly preferred
- Strong communication, negotiation, organizational, and relationship-building skills
- Ability to manage multiple priorities while maintaining accuracy and attention to detail
Ready to Make a Difference?Join a team that values compassion, teamwork, and excellence while making a meaningful impact on the lives of those we serve.
Apply today!Pay is based on experience, qualifications, and skills.
