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Utilization Care Manager Jobs in Arizona (NOW HIRING)

Suvida Healthcare

Nurse Care Manager

Tucson, AZ · On-site

... utilization of resources. The Nurse Care Manager will implement Suvida's care pathways for patients ... with chronic conditions. They will also oversee transitions of care for patients to ensure safe ...

(unknown company)

Care Manager RN FT

Tucson, AZ

... utilization and utilization review. Acts as a liaison between patient/family and healthcare ... Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning ...

Su Vida Services Inc

Nurse Care Manager

Tucson, AZ · On-site

Minimum 2 years of experience in utilization management, case management, chronic care management ... discharge planning, transitions of care management, cost/quality management program, and/or other ...

Suvida

Nurse Care Manager

Tucson, AZ · On-site

Minimum 2 years of experience in utilization management, case management, chronic care management ... discharge planning, transitions of care management, cost/quality management program, and/or other ...

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Utilization Care Manager information

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What are popular job titles related to Utilization Care Manager jobs in Arizona? For Utilization Care Manager jobs in Arizona, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Arizona look for? The top searched job categories for Utilization Care Manager jobs in Arizona are:
Utilization Care Manager jobs near you
Infographic showing various Utilization Care Manager job openings in Arizona as of August 2026, with employment types broken down into 2% As Needed, 73% Full Time, 19% Part Time, and 6% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

RN Care Manager

Arizona Priority Care

Chandler, AZ

Full-time

Re-posted 4 days ago

Job description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

In the role of a RN Care Manager, you will leverage your core skills in managed care, patient service, and nursing to provide high-quality care and support to patients. Your premium skills in Acute care experience will enable you to excel in handling complex medical cases and emergencies effectively. With relevant skills in inpatient and outpatient care, you will collaborate with healthcare teams to ensure seamless transitions and continuity of care. Utilize your expertise in patient assessment, medical terminology, and discharge planning to make a meaningful impact on patient outcomes and healthcare delivery.

POSITION DUTIES & RESPONSIBILITIES

  • Participates in outreach to Medicare Advantage (MA) members for the Telephonic Care Management Program, including in-home, facility or community visits for members when clinically indicated and in support of Complex Care Management goals.
  • Performs ED follow-up calls.
  • Facilitates member/family/caregiver education through referrals to Complex Case Management (CCM), Palliative Care (PC), and Telephonic Care Management, and Hospice as appropriate.
  • Identifies any psychosocial needs of the member and facilitates referrals to social work and/or behavioral health, as necessary.
  • Documents relevant changes in qHMO of member's condition or status, as they occur.
  • Completes the initial hospital admission review, and collaborates with AZPC Medical Directors, for medical necessity determination for in-network hospitalized members.
  • Performs re-reviews on all status changes, and collaborates with the Medical Director for appropriate status determination.
  • Writes appropriate rationales on all reviews that do not meet status requests.
  • Performs re-reviews on all disputed Provider Dispute Resolutions (PDR's), and collaborates with the Medical Director for medical necessity determinations.
  • Reviews Skilled Nursing Facility, Acute Rehab and Long-Term Acute Care requests for appropriate disposition with the Medical Director, and informs the hospital case manager of decision.
  • Assists the Skilled Nursing Facility with discharge planning to ensure timely and safe discharges.
  • Identifies and submits to the Quality Department any potential quality issues for review as well as utilization issues; e.g., over/under utilization, delay of service issues, etc.
  • Identifies and submits Potential Quality Incidents (PQIs) to the Medical Director.
  • Equally shares in after-hours, weekend rotation and Holiday coverage for Care Coordination Department.
  • Participates in Interdisciplinary Care Team.
  • Strong teamwork philosophy and willingness to accept change proactively.
  • Other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE

  • Current, unrestricted AZ Nursing license required. – BSN RN preferred.
  • Knowledge of Medicare, state, and local managed care regulations, prior experience in Managed Care setting preferred.
  • 5 years acute care of care management experience. Medical, ER, Tele, ICE or other relevant clinical role requiring quick critical thinking experience preferred.
  • Must have the ability to present clinical information both accurately and confidently.
  • Reliable personal transportation with valid driver's license, current auto insurance, and acceptable driving record required.
  • Able to communicate effectively and in a professional manner with all levels of internal staff and external customers.
  • Ability to be detail-oriented, able to function under pressure and able to prioritize and re-prioritize tasks as needed.
  • Ability to work both independently and as part of a team, with minimal supervision.
  • Excellent customer service and communication skills, both oral and written.
  • Ability to navigate numerous Electronic Health Records Systems.