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Remote Utilization Management Nurse Jobs in Arizona

University of Kentucky

Utilization Management Reviewer Requisition Number: R-000002878 Department Name: Supervisor, Utilization Review Work Location: UK Chandler Hospital, Pavilion A Grade Level: 11 Type of Position:

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

Oscar Health

Sr. Quality of Care Review Nurse

Tempe, AZ · Remote

$83K - $109K/yr

You will report into the Nurse Manager, Quality of Care. Work Location: This is a remote position ... Health plan utilization management experience or case management experience. * Experience in health ...

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How much do remote utilization management nurse jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote utilization management nurse 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 the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

What is a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

What are the key skills and qualifications needed to thrive as a remote utilization management nurse?

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.
More about Remote Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Arizona? The most popular types of Utilization Management Nurse jobs in Arizona are:
What are popular job titles related to Remote Utilization Management Nurse jobs in Arizona? For Remote Utilization Management Nurse jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Arizona look for? The top searched job categories for Remote Utilization Management Nurse jobs in Arizona are:
What cities in Arizona are hiring for Remote Utilization Management Nurse jobs? Cities in Arizona with the most Remote Utilization Management Nurse job openings:
Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Arizona as of August 2026, with employment types broken down into 3% As Needed, 85% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $81,956 per year, or $39.4 per hour.

Utilization Management Nurse

Valenz Health

Phoenix, AZ • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Job description

Vālenz® Health is the platform to simplify healthcare - the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey - from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About This Opportunity: As a Utilization Management Nurse, you'll oversee and manage the Utilization Management process to ensure the appropriate, necessary, and cost-effective delivery of healthcare services to plan participants. You will review UM activities, including prospective, concurrent, and retrospective reviews, and collaborate with our internal teams and healthcare professionals to ensure the delivery of high-quality care while minimizing unnecessary healthcare expenses.
Things You'll Do Here:
  • Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request.
  • Collaborate with appropriate parties to apply the correct UM criteria within the appropriate timelines.
  • Promote quality care and cost-effective outcomes that enhance the physical, psychosocial, and vacation health of plan participants.
  • Ensure compliance with regulatory standards and guidelines related to UM activities, such as those set forth by CMS, URAC, and other regulatory agencies.
  • Identify and report cases of potential overutilization, underutilization, or improper utilization of healthcare services.
  • Identify potential catastrophic, high-risk, and disease management cases and refer cases to the appropriate team.
  • Communicate UM decisions and recommendations to healthcare providers and plan participants.
  • Maintain accurate and complete records of UM activities and ensure confidentiality of sensitive information.
  • Participate in ongoing UM education and training to stay up-to-date with industry developments.
  • Maintain a high level of confidentiality in accordance with HIPAA.
  • Maintain an active role in assuring continuity of care for all inpatients through early discharge planning.
  • Identify and communicate to the Quality Improvement Coordinator potential quality of care and patient safety issues.
  • Perform other duties as assigned
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
What You'll Bring to the Team:
  • 3+ years of clinical nursing experience.
  • Active, Unrestricted RN License in your state of residence.
  • Ability to work in a fast-paced, detailed, deadline-driven environment.
  • Ability to maintain strict confidentiality and handle sensitive information with discretion.
  • Experience working independently with strong problem solving and organization skills.
  • Strong aptitude for relationship building with a highly effective communication style.
A plus if you have:
  • Utilization Management or Case Management Certification.

Where You'll Work: This is a fully remote position, and we'll provide all the necessary equipment!
  • Work Environment: You'll need a quiet workspace that is free from distractions.
  • Technology: Reliable internet connection-if you can use streaming services, you're good to go!
  • Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
  • Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Schedule: This role follows a full time, Monday through Friday schedule during standard business hours. Below you'll find the schedule according to your time zone.
  • EST: 9:30am to 6pm
  • CST: 8:30am to 5pm
  • MST: 7:30am to 4pm
  • PST: 6:30am to 3pm

Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America's fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare.With this commitment, you'll find an engaged culture - one that stands strong, vigorous, and healthy in all we do.
Benefits
  • Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
  • Spending account options: HSA, FSA, and DCFSA
  • 401K with company match and immediate vesting
  • Flexible working environment
  • Generous Paid Time Off to include vacation, sick leave, and paid holidays
  • Employee Assistance Program that includes professional counseling, referrals, and additional services
  • Paid maternity and paternity leave
  • Pet insurance
  • Employee discounts on phone plans, car rentals and computers
  • Community giveback opportunities, including paid time off for philanthropic endeavors

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

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