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Remote Utilization Review Jobs in Goodyear, AZ (NOW HIRING)

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 ...

Tango Care

Physician Reviewer (Remote)

Phoenix, AZ · On-site +1

Remote - flexible hours Essential Functions: * Perform focused real-time case reviews by reviewing ... Provides medical guidance and review activities for home health utilization management and medical ...

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 ...

New

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 4, 2026, the average hourly pay for remote utilization review in Goodyear, AZ is $41.31, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.45 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 Goodyear, AZ?

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

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

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

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Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Goodyear, AZ as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 84% Physical, 4% Hybrid, and 12% Remote job distribution, with an average salary of $85,928 per year, or $41.3 per hour.

Utilization Management (UM) Clinical Support Specialist (Remote)

Tango Care

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 6 days ago

Job description

Description
tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care.
We are currently looking for a UM Clinical Support Specialist to join our growing team!
** This is a Non-Clinical role and Clinicians will not be considered **
The UM Clinical Support Specialist plays a vital role in supporting the leadership of the Utilization Management team by collecting, analyzing, and reporting data. This position is responsible for maintaining utilization and productivity logs, developing, and monitoring reports, and ensuring accurate and timely documentation. The role also provides administrative support to the clinical team by managing inbound and outbound calls that do not require clinical intervention, review referrals for completeness, assisting reviewers with obtaining clinical information when needed, and supporting compliance, training, and appeal processes
Office Location:
  • Office located at 2415 E Camelback Road, Suite 700, Phoenix, AZ 85020
  • Remote (MST or PST time zone)

Essential Functions:
  • Works independently with minimal supervision and demonstrates accountability for work quality.
  • Support the UM Director and Supervisor in data collection and analysis.
  • Creates and manage comprehensive reports on utilization and productivity and performance trends.
  • Reviews the human resource credentialing reports with the Supervisor to ensure clinician licenses remain current in all applicable states.
  • Monitors Relias for completion of mandatory training and ensure staff compliance within required timelines.
  • Records and tracks QIO appeal requests and provides assistance as needed.
  • Assists the clinical team by managing non-clinical calls, inquires and administrative tasks.
  • Assists the clinical team by reviewing referrals for missing clinical documentation and obtaining clinical information from providers or facilities when necessary and providing decision notifications back to the providers.
  • Assist UM reviewers with administrative tasks in relation to the PA/RA/Appeals process.
  • Assist UM department with non-clinical RA decisions.
  • Answers and resolves portal tickets in a timely manner.
  • Maintains accurate logs, tracks data trends and identifies opportunities for process improvements.
  • Exhibits a professional, pleasant and welcoming demeanor both in person and on the phone.
  • Schedules 1:1 meetings for leadership and staff as directed.
  • Other duties as assigned.

Qualifications:
  • Associate degree in healthcare administration, business administration, or a related field required; Bachelor's degree preferred.
  • Proven experience in a healthcare support role, particularly in data collection and reporting.
  • Prior experience supporting clinical teams and handling administrative tasks related to healthcare services.

Knowledge and Experience:
  • Proficiency in relevant software applications (e.g., Excel, Power BI, database management systems).
  • General medical knowledge.
  • Understanding of healthcare utilization management processes and terminology.
  • Awareness of privacy regulations and data security practices in healthcare.
  • Excellent organizational skills with strong attention to detail.
  • Critical thinking and troubleshooting skills.
  • Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
  • Well-developed interpersonal and communication skills.
  • Professional appearance and manner.
  • Ability to work both independently and collaboratively in a team environment.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

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