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Remote Utilization Review Rn Jobs in Arizona (NOW HIRING)

CommonSpirit Health

Care Transformation RN

Phoenix, AZ · Remote

$41.14 - $67.88/hr

Job Summary and Responsibilities Thiis is a remote position requring travel to support enterprise ... Serve as a Virtual RN (VIC RN) for 50% of the role, providing direct patient care during ...

UnitedHealth Group

Case Manager RN

Tucson, AZ · Remote

$60K - $107K/yr

... utilization. This role includes high-volume telephonic outreach, patient education, and ... reviews, scheduling timely follow up appointments, and providing education on discharge ...

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

Remote Utilization Review Rn information

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$19

$39

$64

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

As of Aug 21, 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 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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 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.

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:

What are popular job titles related to Remote Utilization Review Rn jobs in Arizona?

For Remote Utilization Review Rn jobs in Arizona, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Arizona look for?

The top searched job categories for Remote Utilization Review Rn jobs in Arizona are:

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
Infographic showing various Remote Utilization Review Rn job openings in Arizona as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 12% Part Time, 2% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $81,956 per year, or $39.4 per hour.

Integrated Care Manager- Adult - Remote-AZ

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Medical

Re-posted 14 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

293rd of 311 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. Ensures care meets individual healthcare needs while promoting quality and cost-effective outcomes. This role is primarily focused on case management but may assist with utilization management if needed.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
  • 2 years of full-time equivalent experience in direct clinical care to consumers

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

Required Licenses
  • Active, current, unrestricted license in Arizona (or eligible via endorsement) as a behavioral health professional such as LCSW, LPC, LISAC, LMFT, or licensed psychologist (Psy.D. or Ph.D.) OR
  • Active, current, unrestricted RN license in Arizona or a Nurse Licensure Compact (NLC) state

Required Certifications
  • Within 4 years of hire, must obtain one of the following case management certifications:
    CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, or RN-BC

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 3 years of direct clinical care experience (managed care case management preferred)
  • 1-2 years of experience in a managed care organization

Preferred Education
  • Bachelor's Degree in Nursing or Health and Human Services

Preferred Licenses
  • None

Preferred Certifications
  • Active case management certification (CCM, CDMS, CMAC, CMC, CRC, CRRC, COHN, RN-C, RN-BC)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Assess and collect member data from all care settings
  • Collaborate with providers, members, and families to implement care plans
  • Handle high-volume health insurance-related customer calls daily
  • Explain benefits, coverage, eligibility, claims, programs, and networks
  • Review medical records and determine medical necessity based on criteria and benefits
  • Present case status updates to leadership and medical director as needed
  • Coordinate with internal departments, providers, and external agencies
  • Meet quality, productivity, and timeliness standards
  • Maintain compliance with state, federal, and accreditation requirements
  • Ensure accurate and complete documentation
  • Apply policies and procedures effectively

Team Support (when applicable)
  • Assist in workload distribution
  • Monitor and report team progress
  • Communicate issues and improvement opportunities
  • Mentor and support team members
  • Participate in continuing education in healthcare, behavioral health, and managed care annually

Work Schedule
  • Full-time role (minimum 40 hours per week)
  • Additional hours may be required based on business needs
  • Perform other duties as assigned

COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
  • Intermediate PC skills
  • Intermediate use of office equipment (copiers, fax, scanners, phones)
  • Intermediate skills in word processing, spreadsheets, and databases

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Advanced clinical knowledge
  • Strong interpersonal and active listening skills
  • Ability to interpret and explain policies and procedures
  • Strong analytical and research skills
  • Organizational skills with ability to manage multiple priorities
  • Ability to follow direction
  • Team collaboration skills
  • Sound judgment and problem-solving ability
  • Ability to manage and maintain data across multiple systems

Required Leadership Competencies
  • Conflict resolution
  • Ability to represent the organization 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
  • Familiarity with InterQual, MCG, ASAM, or similar criteria tools
  • Understanding of organizational services and operations
  • Knowledge of patient education and behavior change techniques

Preferred Leadership Competencies
  • None

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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