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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 ...

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$19

$39

$64

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

As of Aug 21, 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 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.

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.

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 2% As Needed, 86% 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.

RN Utilization Management Care Reviewer

Banner Health

Phoenix, AZ • Remote

$37.14 - $61.90/hr

Full-time

Posted 24 days ago

Banner Health rating

7.5

Company rating: 7.5 out of 10

Based on 769 frontline employees who took The Breakroom Quiz

237th of 891 rated healthcare providers

Job description

Department Name:

Utilization Mgmt

Work Shift:

Day

Job Category:

Clinical Care

Nursing careers are better at Banner Health. We’ve built smarter processes to help nurses focus on what really matters. If you want to make a difference in people’s lives - this could be the opportunity you’ve been waiting for. 

As a Remote RN Utilization Management Care Reviewer, you’ll play a critical role in ensuring our Medicare Advantage and AHCCCS members receive the right care at the right time while supporting safe, successful transitions after hospitalization. Collaborating with post-acute facilities and interdisciplinary care teams, you’ll apply your clinical expertise to review medical necessity, optimize length of stay, and help improve member outcomes. If you have a passion for utilization management, care coordination, or case management—and experience with MCG or InterQual is a plus—we’d love to hear from you! 

 

This is a remote, salaried opportunity. CANDIDATES MUST RESIDE IN THE STATE OF ARIZONA. The schedule is as follows: Monday-Friday 8am-5pm, no weekends, and major holidays off,

Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY
This position, within the Utilization Management Department, will determine the medical appropriateness of requested services by reviewing clinical information and applying evidenced-based guidelines. This position will interact with providers, members, internal and external service teams to obtain necessary information and communicate determinations. In addition to pre-service, admission, and concurrent review determinations, this position will be responsible for managing length of stay, discharge planning, resources, and identification of potential quality of care or safety concerns.
CORE FUNCTIONS
1. Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines.
2. Analyzes clinical services from members or providers against evidence-based guidelines.
3. Identifies appropriate benefits, eligibility, and expected length of stay for requested services, treatments, and/or procedures.
4. Conducts inpatient reviews to determine financial responsibility. May also perform authorization reviews and/or related duties as needed. Processes requests within required timelines.
5. Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. Makes appropriate referrals to other clinical programs.
6. Collaborates with multidisciplinary teams to promote Banner Health's Integrated model.
7. Adheres to UM policies and procedures.
MINIMUM QUALIFICATIONS


Bachelor’s degree in nursing or equivalent working knowledge.
Active, unrestricted State Registered Nursing (RN) license in good standing. MCG certification or ability to obtain within six months of hire.
Five years of clinical nursing experience or equivalent working knowledge.
Must be highly proficient with computer usage, typing, Microsoft Suite, and possess the ability to navigate through multiple platforms. Must be highly proficient in medical record review including EMR and paper/fax platforms.
PREFERRED QUALIFICATIONS


Two to three years of Utilization Management experience using MCG, CMS, and clinical criteria. MSN preferred. Case Management Certification (CCM or RN-BC or CMCN). Utilization Management Certification. Certified Professional in Healthcare Quality Certification (CPHQ). Experience with Medicare Advantage, ACOs, Commercial, Dual Eligible, AHCCCS, and/or ALTCS. Experience with URAC and NCQA accreditation process. Experience using Medical Management software platforms.
Additional related education and/or experience preferred.

Estimated Pay Range:

$37.14 - $61.90 / hour Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

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