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Cvs Health Utilization Management Remote Jobs in Texas

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

... Health Care Insurance Company. * Knowledge of medical terminology and procedures. * Verbal and ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

Ascension

RN-Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Days l ... Assess and coordinate discharge planning needs with healthcare team members. * May prepare ...

CVS Health

Staff Software Development Engineer

Irving, TX · On-site +1

$118K - $236K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Hybrid position: remote work permitted but must live within commuting distance of designated office ...

CVS Health

Sr. Data Engineer

Irving, TX · On-site +1

$114K - $185K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Hybrid position: remote work permitted but must live within commuting distance of designated office ...

CVS Health

Data Engineer

Irving, TX · On-site +1

$141K - $144K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Hybrid position: remote work permitted but must live within commuting distance of designated office ...

CVS Health

Sr Machine Learning Engineer

Irving, TX · On-site +1

$112K - $185K/yr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Remote work permitted but must live within commuting distance of designated office location and ...

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Cvs Health Utilization Management Remote information

What is the difference between Cvs Health Utilization Management Remote vs Cvs Health Medical Reviewer?

AspectCvs Health Utilization Management RemoteCvs Health Medical Reviewer
CredentialsRN, LPN, or other healthcare licensesRN, MD, or DO licenses
Work EnvironmentRemote, home-basedRemote or onsite, depending on role
Employer & Industry UsageUtilization management for insurance approvalsMedical review for claims and authorizations

Both roles involve healthcare assessments, often requiring similar licenses. Utilization Management Remote focuses on reviewing medical necessity for insurance purposes, while Medical Reviewers may handle detailed case evaluations. Both are remote-friendly and integral to healthcare insurance processes, but differ slightly in scope and responsibilities.

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For Cvs Health Utilization Management Remote jobs in Texas, the most frequently searched job titles are:

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Cvs Health Utilization Management Remote jobs near you
Infographic showing various Cvs Health Utilization Management Remote job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Utilization Management Rep

Pearland, TX • Remote

Allmed Staffing Inc
Recruiting and Staffing Services • 11 - 50 employees
Learn more about Allmed Staffing Incexternal

Full-time

Medical, Dental, Vision, Retirement

Re-posted 29 days ago

Job description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position Overview

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

  • Collaboration and strong communication
  • Accountability for productivity and quality metrics
  • Continuous learning and process improvement
  • Supportive teamwork across clinical and operational departments
  • Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

  • Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
  • Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
  • Accurately document authorization requests within utilization management systems and/or electronic medical record systems
  • Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
  • Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
  • Maintain accurate records and ensure documentation standards are consistently met
  • Support workflow efficiency while managing multiple priorities in a high-volume environment
  • Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

  • 1–3 years of healthcare experience, preferably within:
    • Utilization Management
    • Insurance operations
    • Medical office environments
    • Managed care settings
  • Experience handling high-volume calls in a professional and efficient manner
  • Strong data entry and documentation skills with high attention to detail
  • Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
  • Strong verbal and written communication skills when interacting with providers, members, and internal teams
  • Basic understanding of healthcare authorization processes and insurance workflows
  • Experience using EMR/EHR platforms, case management systems, or related healthcare systems
  • Strong organizational and time-management skills

Preferred Qualifications

  • Experience supporting authorization processes within healthcare operations or managed care settings
  • Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
  • Experience working with provider communication and care coordination activities
    #ZR

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