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Remote Utilization Review Manager Jobs in Arizona

Lincare

Medical Nutrition Spc - Remote

Phoenix, AZ · Remote

$29.25 - $39.25/hr

Conducts nutritional assessments by reviewing medical records, physician orders, and laboratory ... Collaborates remotely with physicians, nurses, case managers, and other healthcare professionals

TEKsystems

REMOTE- Inpatient Coder

Phoenix, AZ · Remote

$22 - $28/hr

Review emergency department medical records and accurately assign ICD-10-CM diagnosis codes, CPT ... Assign facility Evaluation and Management (E/M) levels in accordance with client-specific emergency ...

Gateway Recruiting

TM

Phoenix, AZ · Remote

Account Management & Program Development: * Conduct quarterly business reviews with key accounts to ... Remote monitoring workflow development, Utilization ramp and adoption metrics * Strong executive ...

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Remote Utilization Review Manager information

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 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 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

Clinical Account Representative

Gateway Recruiting

Tucson, AZ • Remote

Full-time

PTO

Re-posted 3 days ago

Job description

Job Summary:

The Clinical Account Representative (CAR) supports the company's growth by driving utilization, supporting key accounts, and delivering education and technical support. This is a sales-forward role focused on account development, workflow optimization, and expanding access to therapy. The CAR operates at the intersection of clinical expertise, relationship management, and commercial execution, ensuring that the company is successfully integrated into heart failure care pathways and delivers measurable patient and economic value.

Job Responsibilities:

1. Sales & Customer Engagement

  • Serve as the primary point of contact for high-volume, established accounts, ensuring seamless onboarding and patient monitoring workflows.
  • Achieve assigned sales and utilization targets within defined accounts.
  • Execute actionable quarterly business plans with clear activity goals and growth drivers.
  • Conduct routine account check-ins to review program performance, identify barriers, and uncover new opportunities.
  • Deliver product demonstrations and participate in educational meetings to drive adoption and expand utilization.
  • Provide competitive insights, including customer feedback and market intelligence.
  • Provide coverage for Territory Managers during PTO, meetings, and peak demand periods.

2. Account Management

  • Maintain CRM documentation for key accounts, including activity notes, opportunities, and follow-ups.
  • Build and sustain strong relationships with physicians, APPs, clinics, and administrators.
  • Conduct quarterly account reviews in collaboration with Territory Manager to support program health, patient volume trends, and operational needs.
  • Support the execution of workflow optimizations to improve patient identification, onboarding, and monitoring processes.

3. Technical & Clinical Support

  • Provide technical troubleshooting for remote monitoring issues and workflow challenges, escalating as needed.
  • Offer procedural case support occasionally for broader territory, focusing on priority accounts.
  • Support training and education for new clinical staff, clinics, and administrators.
  • Participate in product in-services and support clinical data collection as needed.
  • Continue developing strong product competency.

4. Compliance & Collaboration

  • Adhere to all FDA, regulatory, and company quality requirements.
  • Maintain accurate documentation of sales activities, account plans, expenses, and clinical interactions.
  • Collaborate effectively with Territory Managers, Marketing, Professional Education, Clinical Specialists, and sales leadership.
  • Maintain professional, compliant, and positive communication with all hospital and internal stakeholders.

Education and Experience:

Required:

  • Bachelor's degree (Business, Life Sciences, Engineering, or related).
  • Experience: 2-4 years in medical device or healthcare (inside or field).
  • Demonstrates consultative selling skills, including uncovering needs, asking strategic questions, and positioning solutions that drive utilization growth.
  • Track record of ≥100% to goal in the most recent performance year.
  • Account-facing experience with clinicians and administrators (e.g.,clinics, service line leaders).
  • Proficiency with CRM (Salesforce preferred), Excel/analytics, and PowerPoint.
  • Comfortable delivering clinical/technical presentations to audiences of 10–50 stakeholders.

Preferred:

  • Knowledge of reimbursement landscape and payment pathways (highly preferred).
  • Experience at top MedTech organizations (highly preferred).
  • 1-2 years of commercial experience.
  • Experience in Cardiology/HF/EP/Structural Heart or remote monitoring.
  • Prior involvement in value analysis or committee-based selling.
  • Familiarity with Cath lab/OR workflows; basic procedural support experience.