utilization review remote jobs in Phoenix

tango is a leader in the home health management industry and is preparing for significant growth! We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care. We are currently looking for a Physician Reviewer to join our growing team on a full time basis. The Physician Reviewer provides...

Highmark Health is seeking a seasoned Product Management leader for Utilization Management. You will direct strategy, roadmap, and value realization, partnering with UM operations and delivery to shape the UM portfolio and business outcomes.The role requires 7 years in product management and 5 years in leadership, plus deep knowledge of health insurance...

UnitedHealth Group is seeking a Medical Director to provide physician support for Enterprise Clinical Services, focusing on clinical coverage determinations and medical necessity reviews. You will collaborate with leadership to maintain processes and assure cost-effective high-quality care.The role involves remote work from anywhere in the United States,...

Medical DirectorOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion,...

Claims Reviewer Location: Phoenix AZ 85053 (REMOTE) Duration: 6+ Months Pay Range: $28.00/hr on W2 Shift: Mon Fri 8.00 AM 5 PM PST Job Summary Conducts retrospective review of medical/surgical claims and behavioral health claims for inpatient and outpatient services, as it relates to claims inquiry, resolution, audit, and related functions. Applies clinical,...

Summary of Responsibilities:The utility services manager works with all Avenue5 national suppliers regarding utilities at a property, i.e., utility billing, waste, telecom, Wi-Fi, and anything falling under this purview. This role is responsible for managing the onboarding of all national utility supplier accounts for new and existing properties and...

Bill Review Analyst The Bill Review Analyst is responsible for reviewing, auditing and data-entry of bills for multiple states and lines of business. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for auditing bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts...

The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team performance, accountability, and professional development by conducting regular 1:1s, managing performance reviews, and driving compliance with organizational, state, and federal requirements. The...

Job DescriptionPlease read the following job description thoroughly to ensure you are the right fit for this role before applying.PROJECT ENGINEER (Utilities) - Phoenix, AZThis role of Project Engineer is responsible for preparation of detailed design drawings and contract documents for water and wastewater infrastructure projects involving water supply...

POSITION SUMMARY: The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in...

Job Summary Manages day-to-day construction activities, including supervision of craft employees and subcontractors. Schedules field activities in coordination with the project schedule. Is responsible for safety, production goals, quality control, and cost control. May supervise one or more craft groups and/or scopes of work. This position includes three...

Work at Home Part time JR- Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion...

The Utilization Management (UM) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team performance, accountability, and professional development by conducting regular 1:1s, managing performance reviews, and driving compliance with organizational, state, and federal requirements. The...

Blue Cross Blue Shield of Arizona is seeking a health insurance professional to identify, research, and respond to diverse inquiries from internal and external customers, upholding privacy, compliance and exceptional service. The role supports a Workability hybrid framework with on-site, remote, or hybrid options; residency in Arizona preferred for remote...

Become a part of our caring community The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who completes medical necessity and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments are varied and frequently require...

Additional Information Relocation Assistance Available Job Number Job Category Food and Beverage & Culinary Location 5402 East Lincoln Drive, SCOTTSDALE AZ 85253, United States VIEW ON MAP Schedule Full Time Located Remotely? N Position Type Non-Management POSITION SUMMARY Our Utility Cleaners play an important role in support of a number of vital hotel...

Vice President of Bill Review Operations About the Company Innovative healthcare solutions provider specializing in insurance services Industry Insurance Type Privately Held Founded 2004 Employees 501-1000 Categories Insurance Specialties bill review out-of-network repricing primary ppo and alternative repricing administration edi and...

YO AI Labs seeks AI Data Science Domain Experts to review and refine AI-generated content, improving model accuracy and reasoning. You will edit outputs, craft prompts, and provide structured feedback based on rubrics, collaborating remotely with project teams.Strong data interpretation and technical reporting are essential. Remote, part-time contractor role...

Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions...

Now accepting applicants for Focus Group studies. Earn up to $750 per week part-time working from home. Must register to see if you qualify. No Data Entry experience needed.Data Entry Clerk Work From Home - Part Time Remote Focus Group PanelistsOur company is seeking motivated individuals to participate in National & Local Paid Focus Groups, Clinical Trials,...