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Remote Utilization Review Rn Jobs in Arizona (NOW HIRING)

Molina Healthcare

Care Review Clinician (RN)

Tucson, AZ · Remote

$26.41 - $51.49/hr

Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...

Molina Healthcare

Care Review Clinician (RN)

Scottsdale, AZ · Remote

$26.41 - $51.49/hr

Remote position, must reside in Arizona. Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...

CareTalk Health

$35/hr

Registered Nurse Virtual Care & Care Management (1099 / Contract, Remote) CareTalk Health Compact ... Review and summarize with patients in face-to-face virtual visits via Zoom: Medical, surgical, and ...

Tia

Registered Nurse, Virtual Care - Remote

Phoenix, AZ · Remote

$40 - $45/hr

About the Role As a Virtual RN on Tia's Care Connect team, you will support patients through ... is a remote role. You must maintain a quiet, secure, HIPAA-compliant workspace and reliable ...

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

As of May 30, 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 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 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 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 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
Care Review Clinician (RN)

Care Review Clinician (RN)

Molina Healthcare

Tucson, AZ • Remote

$26.41 - $51.49/hr

Full-time

Posted 7 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

146th of 259 rated insurance

Job description

Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN licensure.  The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient.  Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process.

 

Remote position, must reside in Arizona.

Work hours: Monday - Friday 8:30am- 5:00pm Mountain Time with some weekends and holidays. 

 

KNOWLEDGE/SKILLS/ABILITIES

  • Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
  • Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
  • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
  • Conducts inpatient reviews to determine financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed.
  • Processes requests within required timelines.
  • Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
  • Requests additional information from members or providers in consistent and efficient manner.
  • Makes appropriate referrals to other clinical programs.
  • Collaborates with multidisciplinary teams to promote Molina Care Model.
  • Adheres to UM policies and procedures.
  • Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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