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Remote Utilization Review Jobs in Apache Junction, AZ

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 ... Remote or onsite depending on business needs * Must have a secure home office setup if remote

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

USA- Remote in approved states Overview: TEEMA is partnering with a leading organization supporting ... Review medical records to identify potential quality, safety, and utilization concerns * Conduct ...

Upward Health

Nurse Care Manager

Phoenix, AZ · Remote

The Nurse Care Manager is a remote role responsible for reviewing electronic health records to gather pertinent clinical, behavioral health, social, and utilization information needed to build ...

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:

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Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for remote utilization review in Apache Junction, AZ is $39.80, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $45.72 per hour, depending on experience, location, and employer.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What are the most commonly searched types of Utilization Review jobs in Apache Junction, AZ?

The most popular types of Utilization Review jobs in Apache Junction, AZ are:

What are popular job titles related to Remote Utilization Review jobs in Apache Junction, AZ?

For Remote Utilization Review jobs in Apache Junction, AZ, the most frequently searched job titles are:

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Cities near Apache Junction, AZ with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Apache Junction, AZ as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $82,789 per year, or $39.8 per hour.

REMOTE RN - Quality Review

TEEMA Group

Phoenix, AZ • Remote

$42 - $43.50/hr

Full-time

Re-posted 18 days ago

Job description

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