Utilization Review Manager

Avalon Health Care•Seattle, WA

1h•$40 - $45•Onsite

About The Position

The Utilization Review Manager at Avalon Care Center Federal Way supports quality resident care, successful care transitions, and reimbursement integrity. The role works closely with interdisciplinary teams, payers, physicians, and referral sources to ensure residents receive the appropriate level of care while supporting operational and financial success. The position manages authorizations and utilization review, communicates resident clinical status and discharge plans to payers, and helps coordinate care transitions. It also supports reimbursement accuracy, census development, and relationships with referral sources and community partners. The posting describes the opportunity as full-time and lists compensation at $40.00–$45.00 per hour, based on experience, qualifications, and skills.

Requirements

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.
Strong communication, negotiation, organizational, and relationship-building skills.
Ability to manage multiple priorities while maintaining accuracy and attention to detail.

Nice To Haves

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 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.

Responsibilities

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.