Utilization Review Manager

Utilization Review Manager

Avalon Care Center Federal Way | Federal Way, WA

$40.00 - $45.00/hour

Full-Time

Why Choose Avalon Care Center Federal Way?

At Avalon, our culture is built on five core values:

Integrity • Trust • Excellence • Accountability • Mutual Respect

At 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.

Avalon Care Center Federal Way is an Equal Opportunity Employer.

If you believe this posting does not comply with Washington law, send notice to legal@avalonhealthcare.com.