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Remote Utilization Review Rn Jobs in Surprise, AZ

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

CLINICAL QUALITY REVIEWER (RN or LCSW) Location: USA- Remote in approved states Overview: TEEMA is ... Review medical records to identify potential quality, safety, and utilization concerns * Conduct ...

TEEMA Group

REMOTE RN - Quality Review

Phoenix, AZ · Remote

$42 - $43.50/hr

Review medical records to identify potential quality, safety, and utilization concerns * Conduct ... Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ...

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Review medical records to identify potential quality, safety, and utilization concerns * Conduct ... Remote or onsite depending on business needs * Must have a secure home office setup if remote

TEEMA Group

Clinical Quality Reviewer - REMOTE

Phoenix, AZ · Remote

$40 - $42/hr

Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ... in Nursing or healthcare-related field * Experience in clinical quality, utilization review, or ...

Banner Health

RN, Case Manager

Phoenix, AZ · Remote

After completing training, it is a remote position with a work schedule of Monday - Friday 8am ... MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally ...

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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 Surprise, AZ is $41.00, according to ZipRecruiter salary data. Most workers in this role earn between $32.40 and $47.07 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.
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Remote Utilization Review Rn jobs near you

Clinical Quality Review Nurse

TEEMA Group

Phoenix, AZ • Remote

$41 - $44/hr

Full-time

Re-posted 13 days ago

Job description

6-9 month contract to hire.

Position Overview

Job Title: CLINICAL QUALITY REVIEWER (RN or LCSW)
Location: USA- Remote in approved states
Overview:
TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety concerns, and supporting quality improvement initiatives across a complex healthcare delivery network. This is an excellent opportunity for a licensed clinical professional with experience in clinical review, utilization management, or healthcare quality within health plans, hospital systems, or government-supported programs.
What you will be doing:

  • Review medical records to identify potential quality, safety, and utilization concerns

  • Conduct detailed case analysis and prepare clear, well-documented summaries and recommendations

  • Support peer review processes and quality improvement initiatives

  • Analyze trends and assist in identifying patterns in care delivery and outcomes

  • Collaborate with clinical leadership, including Medical Directors, to review findings

  • Participate in quality committees and performance improvement efforts

  • Ensure compliance with regulatory requirements and program standards

  • Coordinate with cross-functional teams such as case management, care coordination, and program integrity


What you must have:

  • Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)

  • Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health)

  • U.S. Citizenship required

  • Ability to obtain and maintain a Department of Defense (DoD) background clearance

  • Strong analytical and critical thinking skills

  • Excellent written communication skills


Nice to have:

  • Bachelor’s degree in Nursing or healthcare-related field

  • Experience in clinical quality, utilization review, or case review

  • Familiarity with federal or government healthcare programs

  • Experience with clinical criteria tools (InterQual or similar)

  • Exposure to healthcare data analysis or reporting

Technical Skills

  • Proficiency with Microsoft Office (Word, Excel, Outlook)

  • Comfortable working across multiple systems and electronic medical records

What makes you successful

  • Strong clinical judgment and attention to detail

  • Ability to work independently and manage multiple priorities

  • Analytical mindset with problem-solving ability

  • Clear and professional communication skills

  • Comfortable working in a structured, compliance-driven environment


Other Information:

  • Remote or onsite depending on business needs

  • Must have a secure home office setup if remote

  • Occasional extended hours may be required


Salary/Rate Range: $85,000 – $92,000 annually; Hourly Equivalent: Approximately $41 – $44/hour