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

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

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 ...

Briljent

Clinical Domain Project Manager (PBM)

Phoenix, AZ · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... This is a fully remote, full time engagement with an anticipated duration of ten months and an ...

Briljent

Clinical Domain Project Manager (PBM)

Phoenix, AZ · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, clinical criteria configuration, and pharmacy system implementations, with ... This is a fully remote, full time engagement with an anticipated duration of ten months and an ...

A-Line Staffing Solutions

Be Seen First

Remote Pharmacist - Prior Authorization / PBM Experience

Phoenix, AZ · Remote

$53 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Drug Utilization Review (DUR) * Strong understanding of CMS regulations and managed care pharmacy ... Remote Work Requirements Candidates must have: * A dedicated, quiet workspace free from ...

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:

Oscar Health

Sr. Quality of Care Review Nurse

Tempe, AZ · Remote

$83K - $109K/yr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... Health plan utilization management experience or case management experience. * Experience in health ...

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How much do remote utilization review jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for remote utilization review in Phoenix, AZ is $41.98, according to ZipRecruiter salary data. Most workers in this role earn between $33.17 and $48.22 per hour, depending on experience, location, and employer.

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 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 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 are the most commonly searched types of Utilization Review jobs in Phoenix, AZ?

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

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

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

What job categories do people searching Remote Utilization Review jobs in Phoenix, AZ look for?

The top searched job categories for Remote Utilization Review jobs in Phoenix, AZ are:

What cities near Phoenix, AZ are hiring for Remote Utilization Review jobs?

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

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Phoenix, AZ as of August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 100% Remote job distribution, with an average salary of $87,323 per year, or $42 per hour.

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 4 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

257th of 308 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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