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Remote Insurance Utilization Review Jobs in Austin, TX

Afni, Inc.

Full-Time Remote Insurance Representative

Austin, TX · On-site +1

$39K - $54K/yr

As an Insurance Specialist, you get: * Remote Work. This position is 100% remote. We will send you ... Annual Performance Reviews. We reward your good work with more money. What are the qualifications ...

AO Globe Life

Remote Benefits Specialist

Austin, TX · Remote

Remote Insurance Benefits Advisor - Globe Life AO Globe Life AO is expanding and looking for ... Meet with families virtually to review and enroll them in supplemental life and health-related ...

Amergis Healthcare Staffing

Clinic LPN/LVN

Austin, TX · Remote

Position Summary The Remote LVN supports digital health operations by reviewing and managing ... Prior experience with chart review, utilization management, or clinical documentation * Experience ...

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Remote Insurance Utilization Review information

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$68

How much do remote insurance utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote insurance utilization review in Austin, TX is $41.91, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

What is a remote insurance utilization review?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What skills and qualifications are needed for a remote insurance utilization review specialist?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

What are popular job titles related to Remote Insurance Utilization Review jobs in Austin, TX?

For Remote Insurance Utilization Review jobs in Austin, TX, the most frequently searched job titles are:

What job categories do people searching Remote Insurance Utilization Review jobs in Austin, TX look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Austin, TX are:

What cities near Austin, TX are hiring for Remote Insurance Utilization Review jobs?

Cities near Austin, TX with the most Remote Insurance Utilization Review job openings:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Austin, TX as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,173 per year, or $41.9 per hour.

Medical Director, Utilization Review

Curative HR LLC

Austin, TX • On-site, Remote

$260K - $280K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 7 days ago

Job description

About Curative
Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B, Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today's workforce.
Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team.
If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We're growing fast and looking for teammates who want to help transform health insurance for the better.
Job Summary:
Curative is seeking an enthusiastic and highly skilled Medical Director to join our growing team. This pivotal role will be responsible for overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity determinations. The Medical Director will serve as a key clinical expert, ensuring appropriate resource utilization, promoting evidence-based care, and fostering positive relationships with practitioners through effective peer-to-peer discussions. This is a remote position requiring a "roll up your sleeves" attitude and a genuine excitement for the dynamic and collaborative environment of a startup.
Key Responsibilities:
  • Perform comprehensive medical necessity reviews (prospective, concurrent, and retrospective) for a wide range of healthcare services, applying clinical expertise, established medical policies, and evidence-based guidelines.
  • Conduct thorough prior authorization reviews, ensuring alignment with clinical criteria, regulatory requirements, and contractual agreements.
  • Lead and conduct effective peer-to-peer discussions with requesting practitioners, providing clear clinical rationales for determinations, facilitating open dialogue, and seeking alternative solutions when appropriate.
  • Issue medical necessity denials when warranted, providing comprehensive and well-documented rationales in compliance with all relevant regulations and appeal processes.
  • Collaborate closely with internal teams, including Nurse Practitioners, Care Coordinators, and Operations, to optimize utilization management processes and improve member outcomes.
  • Contribute to the development, review, and revision of medical policies, clinical guidelines, and utilization management protocols.
  • Participate in quality improvement initiatives, audits, and committee meetings as required.
  • Maintain meticulous documentation of all review activities, decisions, and peer-to-peer interactions.
  • Stay abreast of current medical literature, healthcare trends, regulatory changes, and industry best practices in utilization management.
  • Champion a member-centric approach while balancing clinical efficacy and cost-effectiveness.
  • Embrace the fast-paced, evolving nature of a startup environment, demonstrating adaptability and a proactive approach to problem-solving.

Qualifications:
  • Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
  • Board Certification in a medical specialty.
  • Active and unrestricted Medical License in at least one US state, with the ability to obtain additional state licenses as needed (Curative will support additional licensure processes).
  • Minimum of 5 years of clinical practice experience.
  • Minimum of 2-3 years of experience in utilization management, medical review, or prior authorizations within an insurance or managed care organization.
  • Demonstrated success in conducting peer-to-peer discussions with external practitioners, with excellent communication and interpersonal skills.
  • Profound understanding of medical necessity criteria, evidence-based medicine, and healthcare utilization management principles.
  • Strong analytical and critical thinking skills, with the ability to synthesize complex clinical information and make sound medical decisions.
  • Exceptional written and verbal communication skills, capable of explaining complex medical decisions clearly and empathetically.
  • Proficiency with electronic health records (EHR) systems and utilization management software.
  • Self-motivated, highly organized, and able to manage a high volume of cases effectively in a remote work environment.
  • A "roll up your sleeves" attitude and a genuine excitement for contributing to a rapidly growing, innovative startup.
  • No travel required for this position.

Perks & Benefits:
  • Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
    • $0 copays and $0 deductibles (with completion of our Baseline Visit )
    • Preventive and primary care built in
    • Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
    • One-on-one care navigation
    • Chronic condition programs (diabetes, weight, hypertension)
    • Maternity and family planning support
    • 24/7/365 Curative Telehealth
    • Pharmacy benefits
  • Comprehensive dental and vision coverage
  • Employer-provided life and disability coverage with additional supplemental options
  • Flexible spending accounts
  • Flexible work options: remote and in-person opportunities
  • Generous PTO policy plus 11 paid annual company holidays
  • 401K for full-time employees
  • Generous Up to 8-12 weeks paid parental leave, based on role eligibility.

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