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Utilization Review Rn Jobs in Tempe, AZ (NOW HIRING)

HOPCo

RN Case Manager - Utilization Review

Phoenix, AZ · On-site

A Case Manager/Utilization Review Nurse, in collaboration with patients/families, physicians and ... A current and unrestricted Arizona Registered Nurse (RN) license. * Certification in Health Care ...

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

CLINICAL QUALITY REVIEWER (RN or LCSW) Location: USA- Remote in approved states Overview: TEEMA is ... Review medical records to identify potential quality, safety, and utilization concerns * Conduct ...

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 ... Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ...

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Job Summary RN Clinical Quality Reviewer TEEMA Full-time Remote | Phoenix, AZ, United States ... Review medical records to identify potential quality, safety, and utilization concerns * Conduct ...

UnitiMed

RN Case Manager

Phoenix, AZ · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

TEEMA Group

Clinical Quality Reviewer - REMOTE

Phoenix, AZ · Remote

$40 - $42/hr

Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ... in Nursing or healthcare-related field * Experience in clinical quality, utilization review, or ...

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Colorwave Inc

Nurse Case Manager (RN)

Glendale, AZ · On-site

$61K - $100K/yr

Nurse Case Manager (RN) Hospitals on Incredible Health are actively hiring and accepting ... Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for utilization review rn in Tempe, AZ is $40.50, according to ZipRecruiter salary data. Most workers in this role earn between $32.02 and $46.49 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are popular job titles related to Utilization Review Rn jobs in Tempe, AZ? For Utilization Review Rn jobs in Tempe, AZ, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Tempe, AZ look for? The top searched job categories for Utilization Review Rn jobs in Tempe, AZ are:
What cities near Tempe, AZ are hiring for Utilization Review Rn jobs? Cities near Tempe, AZ with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
RN Case Manager - Utilization Review

RN Case Manager - Utilization Review

HOPCo

Phoenix, AZ • On-site

Full-time

Medical, Retirement

Posted 18 days ago

Job description

At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:
  • Competitive Health & Welfare Benefits
  • Monthly $43 stipend to use toward ancillary benefits
  • HSA with qualifying HDHP plans with company match
  • 401k plan with company match (Part-time employees included)
  • Employee Assistance Program that is available 24/7 to provide support
  • Employee Appreciation Days
  • Free Lunch Fridays
  • Closed Holidays

Key Responsibilities:
A Case Manager/Utilization Review Nurse, in collaboration with patients/families, physicians and the interdisciplinary team, provides leadership and advocacy in the coordination of patient-centered care across the continuum to facilitate optimal transitions and progression in care.
  • Conduct concurrent and retrospective reviews of patient medical records to verify the medical necessity of services provided.
  • Assess admission criteria and length of stay, applying standardized clinical guidelines such as InterQual or MCG to justify care levels.
  • Issue pre-authorizations for procedures, medications, and durable medical equipment by providing clinical information to insurance carriers.
  • Collaborate with physicians and other healthcare providers to discuss patient care plans and ensure alignment with coverage policies.
  • Facilitate communication between medical staff and payers to resolve issues related to treatment plans and reimbursement.
  • Identify and refer cases to case management or social work for complex discharge planning needs.
  • Prepare and submit clinical appeals to insurance companies when services are denied, providing documentation to support medical necessity.
  • Track and analyze utilization data to identify trends in resource use, care delays, and claim denials for reporting purposes.

EDUCATION
  • Associate Degree in Nursing (ADN) required,
  • Bachelor of Science in Nursing (BSN) preferred.

EXPERIENCE
  • Three to five years of clinical experience in a direct patient care setting within an acute care hospital required.
  • Previous experience in case management or utilization management required.

REQUIREMENTS
  • A current and unrestricted Arizona Registered Nurse (RN) license.
  • Certification in Health Care Quality and Management (HCQM) or as a Certified Case Manager (CCM) credential preferred.

KNOWLEDGE
  • Medical Necessity Analysis: This skill involves a detailed evaluation of patient medical records. The nurse must critically assess the documented clinical information to determine if the proposed treatments, procedures, and services are medically appropriate and necessary according to established standards.
  • Payer-Provider Liaison: Acting as a crucial communication link, the nurse must effectively mediate between healthcare providers and insurance payers. This requires translating clinical information into the language of insurance requirements to resolve discrepancies and pre-emptively address potential denials.
  • Utilization Data Interpretation: This involves collaborating with the Revenue Cycle Management (RCM) team to analyze utilization data to spot trends, such as patterns in claim denials, delays in care, or inefficient use of resources. This analysis helps inform process improvements and strategic reporting within the healthcare facility.

SKILLS
  • Patient Assessment: Conduct comprehensive assessments of patients' medical, emotional, and social needs to develop individualized discharge plans that ensure continuity of care.
  • Care Coordination: Collaborate with healthcare providers, including doctors, nurses, and therapists, to create an integrated plan of care that addresses clinical needs, equipment, home care, and other requirements.
  • Discharge Planning: Determine the appropriate discharge disposition based on factors such as living situation, mobility, cognitive status, and available support systems. This includes deciding whether patients can return home with services or require care in a facility.
  • Arranging Services: Coordinate necessary post-discharge services, such as home health care, rehabilitation, and durable medical equipment, ensuring that these services are in place before the patient leaves the hospital.
  • Communication: Maintain clear communication with all parties involved in the patient's care, including insurance providers, to secure coverage for post-discharge services and ensure that receiving providers are informed of the patient's needs and changes in their condition.
  • Clinical Guideline Application: Applying standardized clinical criteria, such as InterQual or MCG, is a core function. This involves interpreting complex medical information and using these evidence-based guidelines to objectively justify admission, continued stays, and the appropriate level of care.

ABILITIES
  • Ability to work in a high-stress, fast-paced environment.
  • Ability to develop relationships with providers, staff, patients, families, and payors.
  • Ability to work cooperatively and professionally in a team environment.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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