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Remote Utilization Review Rn Jobs in Gilbert, AZ

TEEMA Group

Medical Director

Phoenix, AZ · Remote

... remote administrative operations and 25% (1 day per week) to your own private practice or locum ... Duties & ResponsibilitiesClinical Governance & Utilization Review * Coverage Determinations:

UnitedHealth Group

Case Manager RN

Phoenix, 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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Remote Utilization Review Rn information

See Gilbert, AZ salary details

$19

$39

$64

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

As of Jul 13, 2026, the average hourly pay for remote utilization review rn in Gilbert, AZ is $39.35, according to ZipRecruiter salary data. Most workers in this role earn between $31.11 and $45.19 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 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 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 popular job titles related to Remote Utilization Review Rn jobs in Gilbert, AZ? For Remote Utilization Review Rn jobs in Gilbert, AZ, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Gilbert, AZ look for? The top searched job categories for Remote Utilization Review Rn jobs in Gilbert, AZ are:
What cities near Gilbert, AZ are hiring for Remote Utilization Review Rn jobs? Cities near Gilbert, AZ 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 Gilbert, AZ as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, and 3% Contract. Highlights an 40% Physical, 4% Hybrid, and 56% Remote job distribution, with an average salary of $81,851 per year, or $39.4 per hour.

Medical Director - Pediatrics

TEEMA Group

Phoenix, AZ • Remote

$140 - $145/hr

Full-time

Posted 8 days ago

Job description

Medical Director – PediatricsRole Summary

Are you an accomplished physician executive with a passion for driving systemic clinical excellence and healthcare transformation? We are seeking a visionary, board-certified pediatric leader to step into the role of Medical Director – Pediatrics for a nationally recognized healthcare organization. In this high-impact executive position, you will provide overarching clinical leadership, quality oversight, and strategic medical policy guidance to ensure high-quality, evidence-based, and cost-effective care across an expansive network. Collaborating closely with clinical and operational leaders, you will champion peer reviews, utilization management, and provider engagement initiatives. This long-term opportunity allows you to leverage your extensive clinical expertise to shape pediatric healthcare delivery on a national scale, all from a flexible remote environment.

Duties & ResponsibilitiesClinical Leadership & Quality Governance

  • Clinical Oversight: Provide strategic clinical leadership and medical policy guidance for comprehensive pediatric healthcare services across multiple business units.

  • Quality Assurance: Lead robust peer review activities, clinical governance, quality reviews, and complex medical necessity evaluations.

  • Policy Development: Support the formulation, optimization, and implementation of evidence-based clinical policies, procedures, and medical guidelines.

  • Performance Partnership: Partner dynamically with operational and clinical leadership to monitor, evaluate, and improve provider performance and patient outcomes.

  • Metric Evaluation: Track and analyze key performance indicators (KPIs), utilization management data, and HEDIS/quality metrics to drive continuous organizational success.

  • Compliance & Accreditation: Support rigorous accreditation processes, regulatory compliance, and organization-wide Quality Improvement (QI) initiatives.

  • Stakeholder Engagement: Collaborate with internal and external stakeholders to substantially enhance both the patient and provider experience.

  • Strategic Planning: Act as a trusted physician executive, participating in long-term strategic planning and multidisciplinary corporate initiatives.

  • Other duties as assigned.

Required Qualifications

  • Educational Credentials: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.

  • Board Certification: Current Board Certification in Pediatrics.

  • Licensure: An active, unrestricted state medical license.

  • Clinical Depth: Minimum of 10 years of hands-on clinical physician experience in pediatrics.

  • Leadership Experience: Minimum of 5 years of dedicated physician leadership experience in a role such as Medical Director, Associate Medical Director, Chief Medical Officer, Department Chair, or Service Line Director.

  • Quality Frameworks: Proven experience directing peer reviews, quality improvement structures, and provider performance management.

  • Core Competencies: Exceptional communication, collaborative relationship-building, and executive leadership skills.

Desired Qualifications

  • Managed Care Expertise: Prior leadership experience within a Health Plan, Managed Care Organization (MCO), or Integrated Delivery Network.

  • Utilization & Review: Direct experience handling Utilization Management, Medical Necessity Reviews, and credentialing oversight.

  • Accreditation Knowledge: Strong familiarity with NCQA, HEDIS, Joint Commission, URAC, or related accreditation bodies.

  • Modern Care Delivery: Background in Population Health systems, Value-Based Care models, and leading multidisciplinary clinical teams.

Location and Work Type

  • Work Type: Full-Time, 40 hours per week. Long-term contract opportunity.

  • Work Setting: 100% Remote (Candidates must reside within approved states).

  • Location: USA – Remote

Compensation, Benefits & Perks

  • Hourly Rate: $140.00 – $145.00 per hour.

  • Perks: Enjoy the ultimate work-life balance with a fully remote schedule while making a profound, macro-level impact on pediatric healthcare systems nationwide.

If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.

I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!