Virginia Mason Medical Center·Seattle, Washington
The Utilization Review Nurse ensures the medical necessity and appropriateness of care for hospitalized patients to optimize outcomes and fiscal responsibility. This involves performing clinical assessments and collaborating with healthcare teams to verify correct levels of care and comply with payer guidelines.
Where You’ll Work Virginia Mason Franciscan Health brings together two award winning health systems in Washington state - CHI Franciscan and Virginia Mason.
As one integrated health system with the most patient access points in western Washington our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers.
At Virginia Mason Franciscan Health you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.
Job Summary and Responsibilities As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and optimal patient outcomes.
You will leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay.
Every day you will perform meticulous clinical assessments, identify and coordinate cost-effective alternatives, and proactively support provider decision-making.
You will collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically, ensuring compliance with payer guidelines and regulatory standards.
To be successful in this role you will have strong analytical skills, persuasive communication, and a steadfast commitment to patient advocacy.
Fiscal stewardship is crucial for navigating complex clinical and financial landscapes, ensuring appropriate resource utilization.
Job Requirements Required Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
Experience in utilization review.
Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
An understanding of variable payor rules and regulations is also required.
Preferred Knowledge of core insurance coverage guidelines and financial principles.
Acute care nursing experience.
Candidates must have a Bachelor's degree in Nursing and at least 3 years of professional hospital nursing experience, including specific experience in utilization review. Knowledge of variable payor rules and regulations is required.
Market context
In Washington, nursing support roles such as Certified Nursing Assistant positions are typically in steady demand across hospitals, long-term care, and outpatient settings. Competition often centers on active state licensure, current CPR/BLS certification, and reliable communication skills, while benefits like health insurance, paid time off, sick leave, dental, and life coverage can help distinguish offers. Before applying, confirm your CNA license status and review the AI-summarized requirements and benefits here to save time versus reading the full original posting.
