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Remote Utilization Review Manager Jobs in Arizona

$65K - $75K/yr

Provides administrative and technical support to the Plan Review Manager, Division Administrators ... Remote work is a management option and not an employee entitlement or right. An agency may ...

Remote Tax Manager

Phoenix, AZ ยท On-site +1

$135K - $195K/yr

Prepare and review: * Individual (1040), business (1120S, 1065), and basic corporate returns ... managing client relationships * Ability to work independently in a remote environment * Strong ...

Account Manager - Remote

Mesa, AZ ยท On-site +1

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

Account Manager - Remote

Mesa, AZ ยท Remote

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

Account Manager - Remote

Mesa, AZ ยท On-site +1

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

Account Manager - Remote

Mesa, AZ ยท Remote

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

Account Manager - Remote

Mesa, AZ ยท Remote

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

Account Manager - Remote

Mesa, AZ ยท Remote

$65K - $75K/yr

Partner with Clinical Managers to promote appropriate medication utilization, patient care outcomes, and cost management initiatives. * Lead recurring business reviews by preparing meeting agendas ...

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 ...

Use data to assess patient demand, provider supply, template utilization, access, visit volume ... reviews, dashboards, action plans, and follow-up mechanisms. * Experience directly managing ...

Use data to assess patient demand, provider supply, template utilization, access, visit volume ... reviews, dashboards, action plans, and follow-up mechanisms. * Experience directly managing ...

Showing results 21-40

Remote Utilization Review Manager information

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 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 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 are the key skills and qualifications needed to thrive as a remote utilization review manager?

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 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:

Physician / Surgery - Orthopedics / Arizona / Permanent / Associate Medical Director - Orthopedic Su

eviCore healthcare

Phoenix, AZ โ€ข Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago


Job description

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides timely peer-to-peer discussions with referring physicians to clarify clinical information and to explain review outcome decisions.Maintains necessary credentials and immediately informs eviCore of any adverse actions relating to medical licenses and/or board certifications.Participates in strategic planning for and evaluation of the Care ManagementThe successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Surgery - Orthopedics, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months).Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredNo nights, no weekends, not call.Predictable work scheduleFull and part time opportunitiesSalaried position with benefitsSupportive organization with collaborative cultureeviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:Flexible scheduling and work/life balance with remote and work from home opportunities4 weeks of PTO(starting) per year plus paid holidaysOne week of CMEEducation assistance, tuition reimbursement and professional certifications Health, dental, vision, and life benefits with employer funded HSAPaid Volunteer Community Service Days Ample opportunities for growth, advancement, and promotion 401k retirement plan with company match of 50% employee contributions up to 6% eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation