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

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 ...

Koantek

Resource Manager

Chandler, AZ · Remote

Remote (Coverage for EST & PST required) Role Overview As the Resource Manager for Koantek ... Utilization & Planning: Monitor and maintain peak utilization rates across the practice to ensure ...

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Remote Pharmacist - Prior Authorization / PBM Experience

Phoenix, AZ · Remote

$53 - $55/hr

Formulary management * Drug Utilization Review (DUR) * Strong understanding of CMS regulations and ... Remote Work Requirements Candidates must have: * A dedicated, quiet workspace free from ...

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Tia

Vice President, Operations - Remote

Phoenix, AZ · Remote

Manager: Chief Medical Officer Location: This is a remote role with meaningful travel required. LA ... Use data to assess patient demand, provider supply, template utilization, access, visit volume ...

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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 14, 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.

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 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.

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 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 are popular job titles related to Remote Utilization Management jobs in Tempe, AZ?

For Remote Utilization Management jobs in Tempe, AZ, the most frequently searched job titles are:

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

Care Review Clinician (RN) Remote (AZ)

Molina Healthcare

Glendale, AZ • Remote

$26.41 - $51.49/hr

Full-time

Posted 20 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

163rd of 307 rated insurance

Job description

JOB DESCRIPTION 

This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure.  The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient.  Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Prefers candidates with 3 years of experience.

Remote position, must reside in Arizona.

Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays. 

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
• Processes requests within required timelines. 
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
• Requests additional information from members or providers as needed. 
• Makes appropriate referrals to other clinical programs. 
• Collaborates with multidisciplinary teams to promote the Molina care model. 
• Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and unrestricted in state of practice. 
• Ability to prioritize and manage multiple deadlines. 
• Excellent organizational, problem-solving and critical-thinking skills. 
• Strong written and verbal communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
• Certified Professional in Healthcare Management (CPHM). 
• Recent hospital experience in an intensive care unit (ICU) or emergency room. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

What Molina Healthcare employees say

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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