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

Banner Health

Registered Nurse RN Coordinator

Tucson, AZ · On-site

Support resource utilization, policy compliance, and process improvement to drive positive patient ... MINIMUM QUALIFICATIONS Must possess a current, valid RN license in state of practice, temporary RN ...

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How much do utilization review rn jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for utilization review rn in Tucson, AZ is $40.05, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $46.01 per hour, depending on experience, location, and employer.

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 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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.

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 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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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 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $83,304 per year, or $40 per hour.

Yoeme Managed Care Utilization Manager

Pascua Yaqui Tribe, AZ

Tucson, AZ • On-site

Full-time

Medical, Retirement, PTO

Re-posted 8 days ago

Job description

Salary: Depends on Qualifications
Location : Tucson, AZ
Job Type: Full-Time
Job Number: 2026-00161
Department: MANAGED CARE
Division: YOEME HEALTH PLAN
Opening Date: 06/01/2026
Closing Date: 8/7/2026 11:59 PM Arizona
Job Summary
The Yoeme Managed Care Utilization Manager (YMCU) works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million program that serves the Tribal membership residing in Pima and Maricopa counties. Scope of responsibility includes assisting in managing the Commercial Health Self-Insurance Plan -Yoeme Woi Health Plan. The YMCU Manager will have knowledge and familiarity with the key elements of commercial insurance regulations, commercial eligibility, and producing Family Status Reports for Woi members. The incumbent evaluates the programmatic procedures and implements resource programs to assist with the overall program goals of providing a coordinated, comprehensive coordination of benefits. In addition, the incumbent performs the following duties serves as the Tribal Administrator of the Health-e-Arizona (HEA) site, administers hospital accessibility, ensures compliance with program policies and procedures, determines the use of external providers, conducting performance evaluations.
Principle Duties and Responsibilities
  1. Provide research, analysis, and recommendations to Health Department Executives which include but are not limited to identifying service improvement procedures, organizational improvements to promote efficiency of service delivery, effective cost control measures, provide recommendations for positive outcomes.
  2. Assist in managing the Commercial Health Self-Insurance Plan - Yoeme Woi Health Plan, in commercial eligibility and producing Family Status Reports for Woi members.
  3. Assist in providing coordination and communication management and guidance across health care service systems to include Inpatient / Outpatient, Specialty services, Pharmacy, CHEF, and special health projects/initiatives.
  4. Serves as the Tribal Administrator for the Health-e-Arizona (HEA) site.
  5. Assist in Hospital / Clinical Coordination and Discharge planning with Nursing and Clinic Coordinators.
  6. Assist in Prior Authorization review with the Specialty Clinic Coordinator outside of YHP members.
  7. Assist in developing and maintaining sound administrative policies and management protocols including budgets, cost determination, fee setting and collection structure, and financial reports.
  8. Performs under minimal supervision with accountability for specific goals/objectives.
  9. Works with the Executive Director, Deputy Director, Medical Director, and others to develop performance improvement targets for the organization's quality, service, and efficiency.
  10. Provides leadership with recommendations for implementing changes targeted at contract policy improvement. Measures and evaluates attainment of results.
  11. Supervise staff to include prioritizing and assigning work, conducting performance evaluations, ensuring staff are trained and employees follow policies and procedures, maintaining a healthy and safe working environment, and making hiring, termination, and disciplinary recommendations.
  12. Responsible for the daily oversight of the referral department.
  13. Ensure adequate staffing to meet production and quality standards of the program.
  14. Monitor ambulatory data, inquiries from eligibility providers, intermediaries, tribal members, and complex issues.
  15. Monitor communication with provider business offices daily; manage workload distributions for Utilization Review Specialists (URS) and contractor letters.
  16. Review and issue formal response letters to contractors about program member additions, deletions, and changes, send out notifications of member disenrollment, and review the FI pend report.
  17. Assign Health Record Numbers (HRN) to newborns/new program enrollees, sign denial letters for YHP and send Urgent Care letters to members.
  18. Post payments for "I" type purchase orders payable by the Yoeme Health Plan Finance Office and payments for EOBRS that did not process through FI download.
  19. Generate ad hoc reports from RPMS and CHSMIS as required, generate an open document list sent to providers, and access RPMS and RIC modules.
  20. Process and coordinate medical referrals for the Phoenix Indian Medical Center (PIMC) and the Pima County El Rio Health Center, provide healthcare for tribal members in Maricopa and Pima County by scheduling appointments, generating purchase orders, and explaining procedures.
  21. Review medical referrals and claims with assigned committee members; determine medical need, the priority of the request, eligibility, and payer and provide authorization of payment.
  22. Act as an advocate for patients; performs liaison and case management activities between patients and healthcare providers; provides patient education about eligibility, diagnosis, and insurance.
  23. Work closely with the Native American Liaison for AHCCCS ensuring equal treatment for our tribal members.
  24. Monitor contractors to ensure they follow the contract in providing health services to tribal members.
  25. Participate in discharge planning for patients to ensure appropriate services are in place and that the client is being discharged to an appropriate level of care.
  26. Perform other duties of a similar nature or level as requested by the supervisor or director.

Required Knowledge, Skills, and Abilities
Knowledge of:
  • Knowledge of commercial contracting for Self-Insurance Plan -Yoeme Woi Plan
  • Knowledge of Blue Cross Blue Shield Health Network
  • Knowledge of managing Tribal Health Programs
  • Indian Health Service Programs, policies and procedures.
  • Community health resources;
  • Medical terminology;
  • Customer service principles;
  • Assess the necessity and urgency of requests for medical services to be provided to members to determine payment for the service.
  • Monitor and report abnormal trends/variations in healthcare patterns;
  • Promote excellence and professionalism in healthcare quality;
  • ICD-9, ICD-10 and CPT coding guidelines.
  • Resource and Patient Management System (RPMS) or similar patient information tracking system;
  • Provide clinical review for all requests for home health and physical therapy, making appropriate assessments for approving payment for the service;
  • Maintain a professional approach with confidentiality;
  • Yaqui culture, customs, resources, and traditions, and/or a willingness to learn.

Skills and Abilities:
  • Identify issues and able to provide resolutions;
  • Remain resourceful and calm in emergencies;
  • Monitor and report abnormal trends/variations in healthcare patterns;
  • Promote excellence and professionalism in healthcare quality;
  • Provide clinical review for all requests for home health and physical therapy, making appropriate assessments for approving payment for the service;
  • Maintain a professional approach with confidentiality;
  • Operating a variety of office equipment, including a computer and related software applications;
  • Effective communication and interpersonal skills as applied to interaction with co-workers, supervisor, management, Council members, and the general public. Ability to sufficiently exchange or convey information and receive verbal and written work instructions.

Education, Certifications and Experience Required
Bachelor's degree in public or business administration, or a related field; plus two (2) years of Utilization Review (UR) experience; with a minimum of two (2) years of supervisory experience, or an equivalent combination of education and experience and experience to successfully perform the essential duties of the job such as those listed.
Special Requirements:
  • Must possess and maintain a valid Arizona Driver's License
  • This position will require the incumbent to work non-traditional hours, nights, and weekends.
  • Must have a current Level 1 Arizona Clearance Card or be able to obtain the Level 1 Arizona Clearance Card within ninety (90) days of hire. Failure to maintain a current Level 1 Clearance Card will result in removal from this position.

The Pascua Yaqui Tribe provides 22 days of Paid Time Off which increases with years of service and 15 paid Holidays per year. We offer a comprehensive healthcare benefit package that surpasses or rivals the biggest organizations in Tucson. We encourage you to stay healthy by providing an onsite Wellness Center. Additionally, the Tribe offers a 401(k) Plan with a generous match in which you're immediately vested along with a profit sharing plan after one year of employment. Sworn police and and fire employees are eligible to make Pre-Tax and After-Tax contirbutions to the Arizona Public Safety Personnel Retirement Systems ("PSPRS").
01
Do you have a Bachelor's Degree in Public Administration, Business Administration, or in a related field?
  • Yes
  • No

02
Do you have two (2) years of Utilization Review (UR) experience?
  • Yes
  • No

03
Do you have a minimum of two (2) years of supervisory experience?
  • Yes
  • No

04
Do you have an equivalent combination of education, training, and relevant experience that demonstrates the ability to successfully perform the responsibilities of the position?
  • Yes
  • No

05
Do you have a current valid Driver's license?
  • Yes
  • No

06
Do you currently have a valid Level 1 Arizona Clearance Card, or are you able to obtain one within ninety (90) days of hire? (Please note: failure to maintain a current Level 1 Clearance Card will result in termination.)
  • Yes
  • No

07
Are you aware that this position will require you to work non-traditional hours, nights, and weekends?
  • Yes
  • No

Required Question

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