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Overnight Remote Utilization Review Jobs in Texas

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

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;

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***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 ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

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 ...

HealthHelp - A WNS Company

Nurse - Clinical Review

Houston, TX · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

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 ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

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 ...

MRIoA

Oral Surgery

Dallas, TX · On-site +1

$299K - $395K/yr

We are currently seeking Board-Certified physicians in TITLE to conduct independent Utilization Reviews . This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no ...

Discovery MSO LLC

Virtual IOP Therapist

Weatherford, TX · Remote

$40 - $45/hr

Prepare and provide clinical information needed for utilization review (UR), including ... Remote/virtual role requiring a private, confidential, and HIPAA-compliant workspace. * Reliable ...

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Overnight Remote Utilization Review information

What is the difference between Overnight Remote Utilization Review vs Daytime Remote Utilization Review?

AspectOvernight Remote Utilization ReviewDaytime Remote Utilization Review
Work HoursTypically overnight shifts, often 10 PM to 6 AMStandard daytime hours, usually 8 AM to 4 PM
CertificationsSame as utilization review roles, e.g., RN, CPC, or other healthcare credentialsSame as overnight roles, requiring similar certifications
Work EnvironmentRemote, focused on reviewing cases during night hoursRemote, reviewing cases during daytime hours
Employer & IndustryHealthcare insurance companies, third-party administratorsSame as overnight, within healthcare and insurance sectors

Overnight Remote Utilization Review involves reviewing cases during night hours, providing flexibility for healthcare providers and insurers. Daytime Remote Utilization Review occurs during regular business hours. Both roles require similar credentials and work environments but differ mainly in shift timing, catering to different operational needs.

What are the main challenges faced by overnight remote utilization review professionals, and how can they be addressed?

Overnight remote utilization review professionals often encounter challenges such as working independently during non-traditional hours, limited immediate access to colleagues or supervisors, and the need to make timely decisions with potentially less available support. To address these challenges, it is important to develop strong self-management skills, establish clear communication channels with team members, and utilize comprehensive digital resources and documentation. Employers typically provide thorough training and access to on-call support to help ensure that overnight staff can make confident, accurate determinations and maintain high-quality patient care standards.

What are the key skills and qualifications needed to thrive as an overnight remote utilization review?

To thrive as an Overnight Remote Utilization Review nurse, you need a current RN license, strong clinical judgment, and experience in acute care or case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare/Medicaid are typically required. Excellent critical thinking, attention to detail, and the ability to communicate clearly in written and verbal forms are vital soft skills for this role. These skills ensure accurate, timely case reviews and effective collaboration with healthcare providers while maintaining compliance with payer requirements.

What is an overnight remote utilization review?

An Overnight Remote Utilization Review position involves evaluating medical records and healthcare services during nighttime hours to ensure that treatments are medically necessary and meet established guidelines. Professionals in this role usually work from home, reviewing patient cases, authorizing or denying services, and collaborating with healthcare providers. This job is crucial for maintaining quality care while controlling healthcare costs, and it often requires clinical credentials such as RN, LPN, or other relevant certifications. Strong analytical, communication, and computer skills are important for success in this remote role.
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 are popular job titles related to Overnight Remote Utilization Review jobs in Texas? For Overnight Remote Utilization Review jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Overnight Remote Utilization Review jobs in Texas look for? The top searched job categories for Overnight Remote Utilization Review jobs in Texas are:
What cities in Texas are hiring for Overnight Remote Utilization Review jobs? Cities in Texas with the most Overnight Remote Utilization Review job openings:
Overnight Remote Utilization Review jobs near you

Utilization Review Nurse

Oscar Health

Dallas, TX • Remote

$35 - $45.94/hr

Full-time

Posted 21 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

252nd of 304 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.

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