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Remote Utilization Review Manager Jobs in Arizona

Abbott

Distribution Field Manager - West

Phoenix, AZ · Remote

$86K - $173K/yr

... utilization in current accounts. Understands and assesses customer's business issues and objectives ... This is a remote sales opportunity and will cover the West Region (AZ/NV/CA/ID/OR/WA) estimated 70 ...

Abbott

Distribution Field Manager - West

Phoenix, AZ · Remote

$86K - $173K/yr

... utilization in current accounts. Understands and assesses customer's business issues and objectives ... This is a remote sales opportunity and will cover the West Region (AZ/NV/CA/ID/OR/WA) estimated 70 ...

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 ...

SMI IMAGING LLC

Radiologist- Remote

Scottsdale, AZ · On-site +1

$319K - $399K/yr

Description The Remote Radiologist is responsible for interpreting diagnostic imaging studies from ... manage and review cases. • Participate in quality assurance, peer review, and virtual team ...

Epiq

Sr. Consultant - Invoice Review

Phoenix, AZ · Remote

As the market leader in spend management solutions, Epiq Global is a trusted partner to 75% of ... JA1 #LI-REMOTE "In compliance with federal law, all persons hired will be required to verify ...

Quavo, Inc.

Account/Client Success Manager

Phoenix, AZ · On-site +1

This is a remote, full-time role with a competitive base salary, bonus, and commission tied to ... Conduct regular cadence calls, business reviews, and strategy sessions to align on goals, surface ...

Valenz Health

Clinical Bill Review Analyst

Phoenix, AZ · On-site +1

... management to payment integrity, plan performance and provider verification. With a 99% client ... This is a fully remote position, and we'll provide all the necessary equipment! * Work Environment:

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Arizona

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:
Remote Utilization Review Manager jobs near you

Integrated Care Manager- Remote AZ

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Medical

Posted 15 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

286th of 303 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  • Onsite: daily onsite requirement based on the essential functions of the job
  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes. This job description is primary for case management functions but can assist with utilization management if a business need arises.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
  • 2 year(s) of experience in full-time equivalent of direct clinical care to the consumer

Required Education
  • Associate's Degree in general field of study or Post High School Nursing Diploma or Master's Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D

Required Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.

Required Certifications
  • Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 3 year(s) of experience in full-time equivalent of direct clinical care to the consumer (managed care CM experience preferred)
  • 1-2 year (s) of experience working in a managed care organization
Preferred Education
  • Bachelor's Degree in Nursing or Health and Human Services related field of study
Preferred Licenses
  • N/A
Preferred Certifications
  • Active and current certification in case management from the following certifications; Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC).

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan.
  • Answer a diverse and high volume of health insurance related customer calls on a daily basis.
  • Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
  • Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
  • Maintain complete and accurate records per department policy.
  • Demonstrate ability to apply plan policies and procedures effectively.
  • When indicated to assist with team/project functions:
    • Collaborate with team to distribute workload/work tasks;
    • Monitor and report team tasks;
    • Communicate team issues and opportunities for improvement to supervisor/manager;
    • Support/mentor team members.
  • Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually.

  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned.

COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Intermediate skill in word processing, spreadsheet, and database software

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Advanced and current clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Interpret and translate policies, procedures, programs, and guidelines
  • Capable of investigative and analytical research
  • Demonstrated organizational skills with the ability to priortize tasks and work with multiple priorities
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Apply independent and sound judgment with good problem solving skills
  • Navigate, gather, input, and maintain data records in multiple system applications

Required Leadership Experience and Competencies
  • Conflict Resolution
  • Represent BCBSAZ in the community

PREFERRED COMPETENCIES
Preferred Job Skills
  • Advanced PC proficiency
  • Knowledge of CPT 2018 and ICD-10 coding

Preferred Professional Competencies
  • Knowledge of managed care, utilization management, and quality management
  • Working knowledge of McKesson InterQual, MCG, ASAM, or other nationally recognized criteria
  • Knowledge of a wide range of matters pertaining to the organizations services and operations
  • Knowledge of health and/or patient education and behavior change techniques

Preferred Leadership Experience and Competencies
  • N/A

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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