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Remote Chiropractic Utilization Review Jobs in Texas

Dane Street

Board-Certified Toxicologist

Houston, TX · Remote

... Record Reviews. This is a fully remote opportunity offering flexible scheduling, allowing you to ... necessity, utilization review, and claims support Expanded credentials as an expert medical ...

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Remote Chiropractic Utilization Review information

What are the key skills and qualifications needed to thrive as a Remote Chiropractic Utilization Review specialist, and why are they important?

To thrive as a Remote Chiropractic Utilization Review specialist, you need a Doctor of Chiropractic degree, a valid state license, and comprehensive knowledge of chiropractic procedures and medical necessity guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certification such as Certified Professional Utilization Review (CPUR) is often required. Strong analytical skills, attention to detail, and effective communication are crucial for evaluating clinical documentation and collaborating with providers. These skills ensure accurate, evidence-based reviews that support appropriate patient care and compliance with insurance standards.

What are some common challenges faced in a remote Chiropractic Utilization Review role, and how can they be managed?

One of the main challenges in a remote Chiropractic Utilization Review role is effectively evaluating clinical documentation to ensure treatment appropriateness without direct patient interaction. Communication with providers can sometimes be limited or delayed, requiring strong written and verbal skills to clarify cases efficiently. Managing time and workflow independently is crucial, as the workload may fluctuate throughout the week. Staying updated with payer guidelines and evidence-based practices is also essential for accurate reviews. Building strong virtual collaboration with team members and providers can help overcome these challenges and maintain high-quality standards.

What is a Remote Chiropractic Utilization Review?

A Remote Chiropractic Utilization Review is a process where licensed chiropractors or healthcare professionals assess the necessity, efficiency, and appropriateness of chiropractic care provided to patients, but do so remotely—often from home or a centralized office. This review typically involves examining patient records, treatment plans, and billing information to ensure that care meets established clinical guidelines and insurance requirements. The goal is to improve patient outcomes, prevent unnecessary treatments, and ensure that services billed to insurance are medically necessary. Remote reviews use secure online systems and may require coordination with treating chiropractors, insurance companies, and other healthcare providers.

What is the difference between Remote Chiropractic Utilization Review vs Remote Chiropractic Billing Specialist?

AspectRemote Chiropractic Utilization ReviewRemote Chiropractic Billing Specialist
Primary RoleAssessing medical necessity and appropriateness of chiropractic treatmentsManaging billing, coding, and insurance claims for chiropractic services
Required CredentialsChiropractic license, possibly certifications in utilization reviewMedical billing certifications, knowledge of coding and insurance policies
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare providers or billing companies
Industry UsageUsed by insurance companies and healthcare organizations to approve treatmentsUsed by billing companies and healthcare providers for claims processing

Remote Chiropractic Utilization Review focuses on evaluating the medical necessity of chiropractic treatments, while Remote Chiropractic Billing Specialist handles billing, coding, and insurance claims. Both roles are remote and require healthcare knowledge, but they serve different functions within the chiropractic industry.

What are the most commonly searched types of Chiropractic Utilization Review jobs in Texas? The most popular types of Chiropractic Utilization Review jobs in Texas are:
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What job categories do people searching Remote Chiropractic Utilization Review jobs in Texas look for? The top searched job categories for Remote Chiropractic Utilization Review jobs in Texas are:
What cities in Texas are hiring for Remote Chiropractic Utilization Review jobs? Cities in Texas with the most Remote Chiropractic Utilization Review job openings:
Remote Chiropractic Utilization Review jobs near you
Infographic showing various Remote Chiropractic Utilization Review job openings in Texas as of May 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 100% Remote job distribution.
Prior Authorization/Concurrent Review Nurse RN (Remote in Texas only, TX RN license required)

Prior Authorization/Concurrent Review Nurse RN (Remote in Texas only, TX RN license required)

Central Health

Austin, TX • On-site, Remote

Full-time

Posted 29 days ago

Job description

Overview
Works with the Utilization Management team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Mentors and trains new team members. Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. This position also trains and mentors new team members as well as assesses services for Sendero members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Utilizes clinical skills to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care for members that are hospitalized in acute, skilled and long-term care settings. Performs telephonic reviews of inpatient hospital admissions and assist with the coordination of
discharge planning needs. Obtains the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs. Evaluates the options and services required to meet the member's health needs, in support and collaboration with disease management interventions. Performs prospective, concurrent & retrospective review of inpatient, outpatient, ambulatory & ancillary services requiring clinical review including all levels of appeal requests.
Hours of operation are Monday through Friday 8 am to 5 pm to include extended hours that may occur on a weekend and/or holidays as required by State and Federal regulations in order to maintain operational compliance.
This position is considered Remote, which means that individuals in this position may work at an approved Offsite location; however, they may be required to occasionally visit a Central Health office in Austin, Texas. Remote work not available for residents of California, Colorado, New York, New Jersey, Hawaii, Maryland, Montana, Pennsylvania, Virginia, or Washington.
Responsibilities
Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without
accommodations):
  • Provides concurrent review and prior authorizations (as needed) according to policy.
  • Perform concurrent and retrospective reviews on all inpatient, facility and appropriate home health services.
  • Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
  • Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and cost.
  • Completes assigned work plan objectives and projects on a timely basis.
  • Collect pertinent documentation and conduct medical services review applying appropriate national standardized medical criteria, Sendero medical policy, and state and federal guidelines.
  • Perform discharge planning activities in coordination with facility or provider case manager.
  • Act as a member/family advocate in coordinating and accessing medical necessity of health care services within the benefit plan.
  • Consult with a Medical Director as appropriate for all requests requiring MD approval or not meeting criteria for approval.
  • Maintain open communication flow with to other care management staff to facilitate smooth transition and
  • follow-up as member is transitioned from one level of care and/or service to another.
  • Seek out opportunities to improve HEDIS, NCQA, URAC or general accreditation and QIA activities.
  • Perform other related tasks as assigned by supervisor or manager and maintains department productivity and quality measures.
  • Attends regular staff meetings, conducts self in a professional manner at all times, and completes assigned work objectives and projects in a timely manner.

Knowledge/Skills/Abilities:
  • Knowledge of Managed Care principles and practices, involving medical and behavioral case management, disease management, utilization and pharmaceutical management.
  • Skilled with clinical knowledge and experience in the treatment of human injuries, diseases, and deformities including symptoms, treatment alternatives, drug properties and interactions, behavioral health conditions and preventive health guidelines.
  • Demonstrated ability to lead, communicate, problem solve, and work effectively with people.
  • Excellent organizational skill with the ability to manage multiple priorities.
  • Work independently and handle multiple projects simultaneously.
  • Knowledge of applicable state, and federal regulations.
  • In depth knowledge of InterQual and other references for length of stay and medical necessity determinations.
  • Subject matter expert with NCQA requirements.
  • Ability to take initiative and see tasks to completion.
  • Computer Literate (Microsoft Office Products).
  • Computer Literate (Microsoft Office Products).
  • Excellent verbal and written communication skills.
  • Ability to abide by Sendero's policies.
  • Ability to maintain attendance to support required quality and quantity of work.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Qualifications
MINIMUM EDUCATION: High School Diploma or equivalent Required and Completion of an accredited (RN) or an accredited (LVN) program Required
MINIMUM EXPERIENCE: One (1) year clinical practice experience Required AND Two (2) years managed care experience with utilization management and/or case management
REQUIRED CERTIFICATIONS/LICENSURE: Holds and maintains these certifications as a professional. Lapsing/expiration of these
certifications/licensure will result in suspension of work:
1. Active, unrestricted State Registered Nursing license in good standing

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