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Remote Utilization Management Jobs in Tempe, AZ (NOW HIRING)

Tango Care

Physician Reviewer (Remote)

Phoenix, AZ · On-site +1

The Physician Reviewer is in a utilization management reviewer role at tango - providing UM case ... Remote - flexible hours Essential Functions: * Perform focused real-time case reviews by reviewing ...

Banner Health

RN Medical Management

Phoenix, AZ · Remote

Ideal candidates have experience in prior authorization or utilization management, experience using CareWebQI/InterQual, possess a strong clinical background, and are comfortable working in a remote ...

TEEMA Group

Medical Director - Pediatrics

Phoenix, AZ · Remote

$140 - $145/hr

Track and analyze key performance indicators (KPIs), utilization management data, and HEDIS/quality ... USA - Remote Compensation, Benefits & Perks * Hourly Rate: $140.00 - $145.00 per hour. * Perks:

TEEMA Group

REMOTE RN - Quality Review

Phoenix, AZ · Remote

$42 - $43.50/hr

... clinical review, utilization management, or healthcare quality within health plans, hospital ... Remote or onsite depending on business needs * Must have a secure home office setup if remote

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 ...

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

... clinical review, utilization management, or healthcare quality within health plans, hospital ... Remote or onsite depending on business needs * Must have a secure home office setup if remote

TEEMA Group

Medical Director

Phoenix, AZ · Remote

$140 - $145/hr

This physician executive role focuses completely on utilization management, medical necessity ... remote administrative operations and 25% (1 day per week) to your own private practice or locum ...

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Remote Utilization Management information

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How much do remote utilization management jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for remote utilization management in Tempe, AZ is $40.50, according to ZipRecruiter salary data. Most workers in this role earn between $32.02 and $46.49 per hour, depending on experience, location, and employer.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What job categories do people searching Remote Utilization Management jobs in Tempe, AZ look for?

The top searched job categories for Remote Utilization Management jobs in Tempe, AZ are:

What cities near Tempe, AZ are hiring for Remote Utilization Management jobs?

Cities near Tempe, AZ with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Tempe, AZ as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $84,233 per year, or $40.5 per hour.

Physician Reviewer (Remote)

Phoenix, AZ • On-site, Remote

Tango Care
See more jobs at Tango Careexternal

Full-time

Posted 4 days ago

Job description

Description
tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.
We are currently looking for a Physician Reviewer to join our growing team on a full time basis!
The Physician Reviewer is in a utilization management reviewer role at tango - providing UM case reviews, peer to peer calls/conversations and consultations in real-time; assisting as a resource with functional areas such as utilization management/review, provider relations and communications, and working with physicians to provide education, peer to peer reviews and support.
Office Location:
Remote - flexible hours
Essential Functions:
  • Perform focused real-time case reviews by reviewing the information in the software system(s).
  • Applies medical judgement and pertinent evidence based clinical guidelines to determine medical necessity on pre-service, concurrent, and retroactive and claims reviews of medical home health services.
  • Reviews Potential Quality Issues (PQIs).
  • The Physician Reviewer will provide quality reviews that address the individual needs of the member, align with medical evidence guidelines, and meet compliance requirements.
  • The Physician Reviewer will identify and appropriately document areas of inappropriate utilization of resources.
  • Participates in inter-rater review cases.
  • Perform Peer-to-Peer case discussions with payer medical directors, PCP's, hospitalists and specialists.
  • The Physician Reviewer must maintain positive relationships with a variety of external and internal stakeholders, including working closely with primary care physicians, specialists, hospitalist physicians, nursing, therapists, and staff, participate in interdisciplinary team meetings.
  • Provides medical guidance and review activities for home health utilization management and medical quality improvement activities and programs in accordance with health plan, regulatory, state, corporate, and NCQA accreditation requirements.
  • Attend and participate as assigned quarterly UM, QM and Compliance Committee Meetings.
  • Provide input on clinical content for specific programs.
  • Evaluate potential quality of care concerns as assigned.
  • Assist in developing and reviewing policies as requested/needed.
  • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice and/or return to acute (RTA's) to improve the quality and cost of care.
  • Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality for home care services.
  • Participate in all aspects of regulatory compliance related to health services functions at tango.
  • The physician Reviewer must function within the virtual environment and be able to work individually, while working collaboratively with the clinical/medical management team.

Qualifications:
  • MD or DO license in good standing and no restrictions in state where UM reviews are conducted.
  • Board certified preferable in a primary care specialty (Internal Medicine, gerontology, Family Medicine, Physical Medicine and Rehabilitation).
  • Must be an actively practicing physician with 10+ years' practice.
  • Course work in the areas of Health Administration, Health Financing and Insurance is helpful.
  • Board Certification through American Board Medical Specialties.

Knowledge and Experience:
  • 3+ years of health plan or IPA experience conducting UM Authorization and determination reviews preferred
  • Peer-to-Peer meeting experience
  • Medicare Advantage, Medicare and Medicaid experience
  • Must be proficient and have good computer and technology skills
  • CMS Chapter 7 Home Health knowledge is a plus
  • Supports a culture of continuous quality improvement
  • 2+ years Milliman Care Guidelines or InterQual experience

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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