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Internship Remote Utilization Review Jobs in Arizona

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Arizona Department of Administration

$71K/yr

Preferred: • Experience in Prior Authorization, Utilization Management, claims review, auditing ... Remote work is a management option and not an employee entitlement or right. An agency may ...

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Internship Remote Utilization Review information

What are the main challenges interns face when working remotely in Utilization Review, and how can they overcome them?

Remote Utilization Review interns often encounter challenges in balancing independent work with effective communication, especially when collaborating with clinical teams or supervisors. Staying organized and proactively reaching out for guidance can help bridge gaps caused by remote settings. Utilizing available digital tools, attending virtual meetings, and participating in team chats fosters connection and learning. Setting a structured daily schedule and seeking regular feedback ensures that interns stay aligned with team goals and develop their review skills efficiently.

What is a Remote Utilization Review Internship?

A Remote Utilization Review Internship is a temporary position, often for students or recent graduates, that allows individuals to work remotely while learning about utilization review processes in healthcare. Interns assist in evaluating medical records, ensuring that healthcare services provided to patients are medically necessary and meet established guidelines. They work under the supervision of licensed professionals, gaining experience in medical documentation, insurance policies, and healthcare regulations. This role is ideal for those interested in healthcare administration, nursing, or case management.

What is the difference between Internship Remote Utilization Review vs Utilization Review Specialist?

AspectInternship Remote Utilization ReviewUtilization Review Specialist
CredentialsTypically pursuing or holding relevant certifications (e.g., CCM, RN)Requires active certification and experience in utilization review
Work EnvironmentRemote, internship setting, often part-time or supervisedFull-time, remote or onsite, with more independent responsibilities
Industry UsageEntry-level, training phase within healthcare and insurance sectorsProfessional role with established responsibilities in healthcare management

In summary, an Internship Remote Utilization Review is a training position for individuals gaining experience in utilization review, often with supervision and limited responsibilities. A Utilization Review Specialist is a fully qualified professional responsible for evaluating healthcare services, requiring certifications and more independence in their role.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Intern, and why are they important?

To thrive as a Remote Utilization Review Intern, you need a foundational understanding of healthcare processes, medical terminology, and insurance guidelines, often supported by a relevant degree or coursework in nursing, health administration, or a related field. Familiarity with electronic medical record (EMR) systems, utilization review software, and HIPAA compliance is typically required. Strong attention to detail, analytical thinking, and effective written communication are standout soft skills in this role. These abilities are crucial for accurately reviewing patient cases, ensuring regulatory compliance, and supporting efficient healthcare delivery from a remote setting.
What are the most commonly searched types of Remote Utilization Review jobs in Arizona? The most popular types of Remote Utilization Review jobs in Arizona are:
What are popular job titles related to Internship Remote Utilization Review jobs in Arizona? For Internship Remote Utilization Review jobs in Arizona, the most frequently searched job titles are:
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What cities in Arizona are hiring for Internship Remote Utilization Review jobs? Cities in Arizona with the most Internship Remote Utilization Review job openings:
Internship Remote Utilization Review jobs near you

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 20 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

250th of 300 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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