Transient, narrow plumes of strong water vapor transport, referred to as atmospheric rivers (ARs), are responsible for much of the precipitation along the West Coast of the United States. The most intense precipitation events are almost always induced by an AR on the coast of Oregon and Washington and can result in detrimental impacts on society due to mudslides and flooding. To accurately predict AR events on numerical weather prediction, subseasonal, and seasonal time scales, it is important to understand the large-scale impacts on extreme AR events. Here, characteristics of ARs that result in an extreme precipitation event are compared to typical ARs on the coast of Washington State. In addition to more intense water vapor transport, notable differences in the synoptic forcing are present during extreme precipitation events that are not present during typical AR events. Subseasonal and seasonal teleconnection patterns are known to influence the weather in the Pacific Northwest and are investigated here. The Madden–Julian oscillation (MJO) plays a role in determining the strength of precipitation associated with an AR on the Washington coast. Phase 5 of the MJO (convection centered over the Maritime Continent) is the most common phase during an extreme precipitation event, while phase 2 (convection over the Indian Ocean) discourages an extreme event from occurring. Interactions between El Niño–Southern Oscillation (ENSO) and the propagation speed of the MJO result in extreme events during phase 1 of the MJO and El Niño but phase 8 during neutral ESNO conditions.