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Insurance Utilization Review Jobs in Arizona (NOW HIRING)

Dane Street

Orthopedics Physician

Concho, AZ · On-site

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

UHS

DISCHARGE PLANNER

Phoenix, AZ · On-site

PRN Varies The Discharge Planner works with the Utilization Review department on certification and recertification of insurance benefits throughout the patient's stay, and assists the treatment team ...

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Insurance Utilization Review information

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$19

$39

$64

How much do insurance utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for insurance utilization review in Arizona is $39.40, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Arizona?

The most popular types of Insurance Utilization Review jobs in Arizona are:

What are popular job titles related to Insurance Utilization Review jobs in Arizona?

For Insurance Utilization Review jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Arizona look for?

The top searched job categories for Insurance Utilization Review jobs in Arizona are:

What cities in Arizona are hiring for Insurance Utilization Review jobs?

Cities in Arizona with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Arizona as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 19% Part Time, and 5% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $81,956 per year, or $39.4 per hour.

Registered Nurse (Patient Navigator)

Exceptional Health Care

Prescott, AZ • On-site

$19.75 - $27/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 27 days ago

Job description

Become a critical lifeline at our new community hospital!
Exceptional Healthcare is seeking a Patient Navigator (RN) in Prescott, AZ.
Summary:
In this role you will serve as a key clinical liaison combining utilization management, care coordination, and provider support to ensure appropriate patient status determinations, medically necessary admissions, and timely transitions of care. This role operates primarily at the point of entry in the Emergency Department (ED) while conducting concurrent reviews on Inpatient and Observation patients.
The ideal candidate is an experienced RN with strong analytical and communication skills focused on revenue integrity, documentation improvement, and regulatory compliance.
As a vital member of our clinical team, you'll deliver exceptional care while maintaining the highest professional standards.
Why EHC:
  • Comfortable patient ratios that allow for true patient connection
  • Greater autonomy, closer team alignment, and genuine connections
  • Opportunities for a path to clinical leadership
  • Cross training opportunities
  • Quicker throughput processes
  • Less administrative friction and direct communication with leadership
  • A modern standalone facility with full spectrum Med Lab, Radiology, and Pharmacy support
  • In-house Respiratory Therapist (24 hr coverage)
What You'll Do
  • Perform real-time triage and clinical review of Emergency Department patients using standardized criteria (e.g., InterQual) to recommend appropriate patient status (Inpatient vs. Observation).
  • Collaborate directly with physicians and providers to present clinical data and secure accurate, timely status decisions.
  • Conduct concurrent utilization reviews and follow-up assessments on admitted Inpatient and Observation patients.
  • Identify and recommend Clinical Documentation Improvement (CDI) opportunities to accurately reflect patient acuity.
  • Lead proactive discharge planning and transition coordination with patients, families, and post-acute care providers.
  • Maintain accurate, timely documentation in the system per regulatory requirements.
  • Educate and mentor clinical staff on utilization management principles, status criteria, and documentation best practices.
  • Participate in performance improvement initiatives and demonstrate a team-oriented, solution-focused approach. • Other duties as assigned.
What You'll Need
Education & Experience:
  • Graduate from an accredited school of nursing; BSN preferred.
  • Active, unrestricted RN license in the state of Arizona (or compact equivalent).
  • Minimum 2-3 years of clinical nursing experience (Emergency Department, Critical Care, Case Management, or Utilization Review strongly preferred).
Skills & Knowledge:
  • Demonstrated proficiency or strong aptitude in applying standardized utilization criteria (InterQual or similar).
  • Excellent interpersonal and communication skills with the ability to present clinical information confidently to physicians.
  • Proficient in Electronic Health Records (EHR) and virtual communication platforms.
  • Strong knowledge of HIPAA, CMS guidelines, and utilization management regulations.

Certifications / Licensing:
  • Current BLS required. ACLS/PALS preferred.

Training Requirement:
  • Ability to successfully complete a comprehensive 2-week on-site training program
Shift:
  • This position is scheduled from 10:00 AM to 10:00 PM, Monday through Saturday, with coverage provided by two staff members.
Why Work With Us
  • Comprehensive health, dental, and vision insurance
  • 401(k) matching and paid time off
  • Career growth and leadership development opportunities
  • State-of-the-art facilities and ongoing education
  • Supportive team environment focused on excellence
  • Opportunity to help build a new healthcare facility
  • Compensation: Competitive hourly rate PLUS night/weekend night hourly pay differentials.

Apply Today! Join our founding team and help establish Exceptional Healthcare as the premier provider of emergency care in our community. Take the next step in advancing your ER nursing career with us.

Apply