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Remote Utilization Review Rn information

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How much do remote utilization review rn jobs pay per hour?

As of Jun 18, 2026, the average hourly pay for remote utilization review rn in Arizona is $39.40, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What is the meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are the most commonly searched types of Utilization Review Rn jobs in Arizona? The most popular types of Utilization Review Rn jobs in Arizona are:
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What cities in Arizona are hiring for Remote Utilization Review Rn jobs? Cities in Arizona with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Sr. Compliance Specialist - Care Management Programs

Sr. Compliance Specialist - Care Management Programs

Valenz Health

Phoenix, AZ • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Job description

Vālenz® Health is the platform to simplify healthcare - the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey - from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About This Opportunity:
As a Sr. Compliance Specialist - Care Management Programs (aka Sr. Product Compliance Specialist - Care), you'll partner with Care Management and Utilization Management teams as the primary compliance resource for regulatory, accreditation, and licensing requirements impacting clinical operations. You'll provide risk-based compliance oversight for areas including CMS regulations, NCQA and URAC standards, multi-state UM licensing requirements, regulatory change management, and other operational initiatives.
You'll work closely with Product, Operations, and Corporate Compliance teams to support policy governance, compliance training, issue intake management, and ongoing efforts to ensure compliance with applicable regulatory and accreditation requirements.
Things You'll Do Here:
  • Serve as the primary compliance liaison for Care Management and Utilization Management operations, providing strategic guidance and oversight to ensure adherence to applicable regulatory and accreditation requirements.
  • Interpret, assess, and operationalize regulatory standards, including CMS Medicare Advantage and Managed Care requirements, NCQA and URAC accreditation standards, Utilization Review and Utilization Management regulations, and 42 CFR Part 2 requirements, as applicable.
  • Oversee and support the organization's multi-state Utilization Management licensing program by tracking licensing requirements across applicable jurisdictions, coordinating license applications and renewals, maintaining supporting documentation, and partnering with operational leaders to ensure ongoing compliance with licensing conditions and regulatory obligations.
  • Provide compliance guidance and subject matter expertise related to clinical workflows, operational processes, policy development, and system implementations impacting Care operations.
  • Support the full lifecycle management of Care-related policies, standard operating procedures, and associated documentation.
  • Monitor regulatory developments and emerging compliance requirements, evaluate operational impact, and communicate relevant updates and recommendations to key stakeholders.
  • Participate in high-risk initiatives, operational enhancements, and product or process changes to ensure compliance considerations are appropriately addressed.
  • Support organizational readiness for audits, regulatory reviews, and accreditation activities, including NCQA and URAC surveys.
  • Assist with incident response activities involving Care operations, including privacy-related inquiries, compliance investigations, and regulatory escalations.
  • Collaborate with Corporate Compliance and cross-functional teams on issue intake, triage, tracking, remediation, and resolution efforts.
  • Provide education, training, and ongoing guidance to internal stakeholders regarding applicable regulatory and compliance requirements.
  • Maintain accurate and organized documentation to support compliance activities, regulatory inquiries, audits, and accreditation requirements.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
What You'll Bring to the Team:
  • Bachelor's degree in Healthcare Administration, Nursing, Public Health, or a related field.
  • 5+ years of experience in healthcare compliance, regulatory affairs, clinical operations, or a related healthcare environment.
  • Demonstrated experience supporting Utilization Management, Care Management, and/or Disease Management programs.
  • Working knowledge of CMS regulatory frameworks and managed care compliance requirements.
  • Experience with NCQA and/or URAC accreditation standards and related operational readiness activities.
  • Strong understanding of multi-state healthcare regulatory and compliance environments.

A plus if you have...
  • Experience managing or supporting multi-state Utilization Management licensure programs.
  • Clinical background, such as Registered Nurse (RN) or equivalent clinical experience.
  • Knowledge of 42 CFR Part 2 requirements and related privacy regulations.
  • Experience operating within a Business Associate environment.
  • Relevant professional certification preferred, such as Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or equivalent.

Where You'll Work: This is a fully remote position, and we'll provide all the necessary equipment!
  • Work Environment: You'll need a quiet workspace that is free from distractions.
  • Technology: Reliable internet connection-if you can use streaming services, you're good to go!
  • Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
  • Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America's fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare.With this commitment, you'll find an engaged culture - one that stands strong, vigorous, and healthy in all we do.
Benefits
  • Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
  • Spending account options: HSA, FSA, and DCFSA
  • 401K with company match and immediate vesting
  • Flexible working environment
  • Generous Paid Time Off to include vacation, sick leave, and paid holidays
  • Employee Assistance Program that includes professional counseling, referrals, and additional services
  • Paid maternity and paternity leave
  • Pet insurance
  • Employee discounts on phone plans, car rentals and computers
  • Community giveback opportunities, including paid time off for philanthropic endeavors

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

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