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Remote Utilization Review Manager Jobs in Arizona

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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Remote Utilization Review Manager information

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

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a Remote Utilization Review Manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

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 Remote Utilization Review Manager jobs in Arizona? For Remote Utilization Review Manager jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Arizona look for? The top searched job categories for Remote Utilization Review Manager jobs in Arizona are:
What cities in Arizona are hiring for Remote Utilization Review Manager jobs? Cities in Arizona with the most Remote Utilization Review Manager job openings:
Remote Utilization Review Manager jobs near you
Utilization Review Nurse

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

225th of 258 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 Diploma Program in Practical Nursing of 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)

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.

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