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Cvs Health Utilization Management Remote Jobs in Texas

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

CVS Health

Remote/Virtual (Using your own personal laptop/computer) Program Overview: * Unpaid Educational ... Risk Management/Insurance, Math, Statistics, Business Analytics, Economics (and related majors)

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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.

What are the most commonly searched types of Cvs Health Utilization Management jobs in Texas? The most popular types of Cvs Health Utilization Management jobs in Texas are:
What are popular job titles related to Cvs Health Utilization Management Remote jobs in Texas? For Cvs Health Utilization Management Remote jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Cvs Health Utilization Management Remote jobs in Texas look for? The top searched job categories for Cvs Health Utilization Management Remote jobs in Texas are:
What cities in Texas are hiring for Cvs Health Utilization Management Remote jobs? Cities in Texas with the most Cvs Health Utilization Management Remote job openings:
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 Nurse (84124)

Regency Integrated Health Services

Austin, TX • Remote

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Primary Responsibilities

The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.

Essential Functions

Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.

Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.

Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member's health need.

Location Requirements

This position is remote but requires the employee to live within our service area, which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.

Educational/Training Requirements

  • Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience.
  • Payor Utilization Management: 3 years recommended experience
  • Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
  • Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.

Licensing Requirements

  • Current unencumbered LVN or RN license in Texas or compact license.

Experience Requirements

  • 2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
  • UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side. 
  • 5+ years of acute clinical experience.
  • The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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About Regency Integrated Health Services

Sourced by ZipRecruiter

Regency Integrated Health Services, located in Victoria, Texas, U.S., is a healthcare provider operating within post-acute healthcare and rehabilitation industry sector. As a well-known name in the industry with an official website at regencyhealthcare.com, the company specializes in offering a wide range of health services which primarily include skilled nursing, rehabilitation, long-term care, and assisted living services. Since its inception, Regency Integrated Health Services has been committed to providing the highest possible standards in healthcare.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Victoria, TX, US

Year founded

2015

Social media

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