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

Registered Nurse

Case Manager RN

Tucson, AZ · On-site

$60 - $107/hr

... utilization. This role includes high-volume telephonic outreach, patient education, and ... reviews, scheduling timely follow up appointments, and providing education on discharge ...

(unknown company)

Care Manager RN PRN

Tucson, AZ · On-site

... 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 ...

New

(unknown company)

Care Manager RN FT

Tucson, AZ · On-site

... 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 ...

(unknown company)

Care Manager RN Full Time

Tucson, AZ · On-site

... 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 ...

Sky Mavis

Manager Utilization Management

Tucson, AZ · On-site

$100 - $140/hr

Active, unrestricted Registered Nurse (RN) license in the state of Arizona, California, Nebraska ... Experience leading utilization management teams within a Medicare Advantage environment.

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How much do utilization review rn jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for utilization review rn in Tucson, AZ is $37.84, according to ZipRecruiter salary data. Most workers in this role earn between $29.90 and $43.46 per hour, depending on experience, location, and employer.

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.

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.

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 get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Tucson, AZ?

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

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For Utilization Review Rn jobs in Tucson, AZ, the most frequently searched job titles are:

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Cities near Tucson, AZ with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Tucson, AZ as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $78,705 per year, or $37.8 per hour.

Utilization Review Specialist

Tucson, AZ • On-site

Lifepoint Health
Health Care and Social Assistance • 10K+ employees

5.9

Company rating: 5.9 out of 10

Based on 272 frontline employees who took The Breakroom Quiz

765th of 895 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about Lifepoint Healthexternal

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Job description


Your experience matters
El Dorado Springs Behavioral Health is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Specialistjoining our team, you're embracing a vital mission dedicated to making communities healthier ®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.
How you'll contribute
A Utilization Review Specialist who excels in this role:
  • Facilitates clinical reviews for all patient admissions and continued stays.
  • Analyzes patient records to determine the appropriateness of admission, treatment, and length of stay, and interfaces with managed care organizations, external reviewers, and other payers.
  • Advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric, or emotional disorders to managed care providers to ensure access to necessary treatment.
  • Contacts external case managers and managed care organizations to obtain certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding requirements for continued stay and discharge planning.
  • Demonstrates knowledge of clinical criteria and managed care requirements for inpatient and outpatient authorization, and advocates for coverage of necessary services.
  • Completes pre-certifications and re-certifications for inpatient and outpatient services; reports denials and authorization information to the appropriate resource.
  • Actively communicates with the interdisciplinary team to obtain pertinent information and provide updates on authorizations.
  • Participates in treatment team meetings to ensure staff understand coverage and to gather information for communication with external agencies.
  • Collaborates with the Director of Nursing (DON) to ensure documentation requirements are met.
  • Ensures appeals are completed thoroughly and in a timely manner.
  • Interfaces with managed care organizations, external reviewers, and other payers.
  • Communicates with physicians to schedule peer-to-peer reviews.
  • Accurately reports denials.

About our Team
Driven by a mission to help individuals regain stability and wellness, our multidisciplinary team works collaboratively to provide compassionate care while fostering a supportive, safety-focused workplace culture for our staff and patients alike.
What we're looking for
Applicants must have a Bachelor's degree (required). Master's degree is preferred. Additional requirements include:
  • Previous utilization review experience in a psychiatric healthcare facility preferred.
  • Current unencumbered clinical license is strongly preferred.
  • CPR certification and Crisis Prevention Training (CPI) preferred. May be required to work flexible hours and overtime

Schedule: PRN (as needed)
This position does not have a set weekly schedule. You'll be called in to work when extra help is needed-such as covering for someone, handling busy periods, or filling gaps in the schedule. Hours can vary from week to week, and there's no guaranteed hours.
Why join us
We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:
  • Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
  • Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
  • Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
  • Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
  • Professional Development: Ongoing learning and career advancement opportunities.

More about El Dorado Springs
El Dorado Springs features a state-of-the-art facility with over 100 private and semi-private rooms, providing a secure and therapeutic setting focused on comfort, dignity, and healing. Patients receive 24/7 medically supervised care, evidence-based therapy, medication management, and comprehensive discharge and aftercare planning.
Accredited by The Joint Commission and certified by CMS, El Dorado Springs Behavioral Health is committed to delivering relationship-centered, evidence-based care that improves outcomes and supports long-term recovery.
The hospital offers a full continuum of care, including inpatient psychiatric stabilization, medically assisted detox (MAT), Partial Hospitalization Program (PHP), and Intensive Outpatient Program (IOP). These programs are designed to support individuals experiencing acute mental health symptoms, substance use disorders, or co-occurring conditions in a safe, structured environment.
EEOC Statement
El Dorado Springs Behavioral Health is an Equal Opportunity Employer. El Dorado Springs Behavioral Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."
About Us
Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.
About the Team
We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.
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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

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Hours and flexibility

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