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Assistant Remote Utilization Review Jobs in Texas

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

Performs utilization review of cases to determine if the request meets medical necessity criteria ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

S. • Minimum of one (1) year experience in utilization review, or utilization management • ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

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Assistant Remote Utilization Review information

What is the difference between Assistant Remote Utilization Review vs Utilization Review Nurse?

AspectAssistant Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certification in case management or utilization reviewRegistered Nurse (RN) license, often with additional certifications in case management or utilization review
Work EnvironmentRemote, administrative setting, telehealth or telecommutingRemote or hospital/clinic settings, primarily telehealth or administrative
Employer & IndustryHealth insurance companies, managed care organizations, healthcare providersHospitals, insurance companies, healthcare organizations

Both roles involve reviewing patient cases to determine appropriate care and resource utilization. The Assistant Remote Utilization Review typically supports the process with administrative tasks and basic review, while the Utilization Review Nurse performs more in-depth clinical assessments. Both require nursing credentials and often work remotely within healthcare or insurance industries.

What are the most commonly searched types of Remote Utilization Review jobs in Texas? The most popular types of Remote Utilization Review jobs in Texas are:
What cities in Texas are hiring for Assistant Remote Utilization Review jobs? Cities in Texas with the most Assistant Remote Utilization Review job openings:
Utilization Review Nurse

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Posted yesterday


Job description

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***

JOB DESCRIPTION:

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

JOB RESPONSIBILITIES:

  • This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
  • Collects clinical and non-clinical data.
  • Verifies eligibility.
  • Determines benefit levels in accordance to contract guidelines.
  • Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.

JOB QUALIFICATIONS (Required):

  • Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.

JOB QUALIFICATIONS (Preferred):

  • MCG or InterQual experience
  • Utilization management experience

LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin Counties).

POSITION: 6-month assignment