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Utilization Care Manager Jobs in Arizona (NOW HIRING)

Actalent

Clinical Concurrent Review Nurse

Phoenix, AZ · On-site

Support care coordination efforts through referrals to care management, case management, and other support services as appropriate. * Educate providers on utilization management processes, clinical ...

Centstone HC

Registered Nurse Utilization

Tuba City, AZ · On-site

This role focuses on reviewing medical necessity, coordinating patient care, supporting discharge ... The ideal candidate will work closely with physicians, case management, and interdisciplinary teams ...

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Utilization Care Manager information

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.

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 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 does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

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 88% Physical, 2% Hybrid, and 10% Remote job distribution.

RN-Chronic Care Management

Canyonlands Community Health Care

Page, AZ • On-site

$73K - $103K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 29 days ago

Job description

Description

Basic Function: 


This position assumes advocacy and accountability for an identified group of patients during all or part of  the continuum of care. Focuses on primary disease prevention and improving quality of care for chronically ill patients and  outreach to patients to be more engaged in their overall health and wellness through care planning and management.  Collaborates with the health care team members to identify appropriate utilization of resources. 




  • Loan repayment qualified
  • CME stipend plus one-week paid CME per year
  • Vacation Time
  • Paid Leave
  • Medical, dental, vision, life, short-term & long-term disability
  • Paid license, membership fees
  • Retirement plan offered



Requirements

Essential Functions: 


1. Collaborates with health care staff responsible for patient care to develop, implement, monitor and evaluate appropriate  clinical care or other services to meet the needs of patient and coordinates all activities related to chronic care management.  

2. Plans for, ensures access to, and evaluates the effectiveness of care at the next level of care along the continuum of care.  

3. Ensures that areas of responsibility are operating in compliance, including documentation and records with all federal,  state, and regulatory agencies.  

4. With the primary care team, identifies patients to be case managed, assesses patient's care requirements, modifies or  coordinates modification of patient care and intervenes, as necessary.  

5. Coordinates in the development and review of clinical pathway trends and shares with appropriate service and  management teams. 

6. Assist with monitoring of quality improvement elements including establishment of program measures and  implementation of action plans. 

7. Works directly with the Population Health Director and Community Health Workers to establish and implement outreach  tasks and patient centered engagement.  

8. Monitors trends and implements strategies to assist patient with accessing appropriate level of care.  


Canyonlands Healthcare is an Equal Opportunity Employer. Please contact HR at 928.645.9675 ext 2212. Applications are required and are available online at www.canyonlandschc.org/ Resumes may be attached to the application but will not be accepted in lieu of a completed application. Successful completion of a background check and drug screen are a prerequisite to employment. Applications are accepted until position is filled. 

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