ZipRecruiter

Log In

1

Utilization Review Jobs in Gilbert, AZ (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

UHS

Utilization Review Manager

Phoenix, AZ

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ · On-site

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

UHS

Utilization Review Manager

Phoenix, AZ

Responsibilities Utilization Review Manager (URM) Position: Full-Time Shift: Daytime This position includes a $1,500 sign on bonus! For over 60 years, Calvary Healing Center has provided a full ...

next page

Showing results 1-20

All JobsUtilization Review JobsUtilization Review Jobs in Gilbert, AZ

Utilization Review information

See Gilbert, AZ salary details

$20

$40

$66

How much do utilization review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review in Gilbert, AZ is $40.97, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.07 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Gilbert, AZ? The most popular types of Utilization Review jobs in Gilbert, AZ are:
What are popular job titles related to Utilization Review jobs in Gilbert, AZ? For Utilization Review jobs in Gilbert, AZ, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Gilbert, AZ look for? The top searched job categories for Utilization Review jobs in Gilbert, AZ are:
What cities near Gilbert, AZ are hiring for Utilization Review jobs? Cities near Gilbert, AZ with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Gilbert, AZ as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, and 5% Contract. Highlights an 87% Physical, 6% Hybrid, and 7% Remote job distribution, with an average salary of $85,209 per year, or $41 per hour.

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 27 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 303 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

What Oscar Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom