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Remote Insurance Utilization Review Jobs in Houston, TX

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

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

... Insurance, Shipping and Logistics, and Travel and Hospitality. We bring together deep domain ... S. • Minimum of one (1) year experience in utilization review, or utilization management • ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

Performs utilization review of cases to determine if the request meets medical necessity criteria ... Remote Compensation Disclosure The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

S. • Minimum of two (2) years experience in utilization review, case management, or clinical ... Remote Compensation Disclosure The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] ...

YO AI Labs

Hospitalist Physician - Remote

Houston, TX · Remote

$70 - $100/hr

Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...

MD Anderson

Financial Clearance Coordinator

Houston, TX · Remote

$42.79 - $53.37/hr

Remote but must be able to come onsite as needed. Why Us. At UT MD Anderson, this role directly ... in utilization review, insurance, case management, or medical clearance. Preferred: 2 years ...

Mercor

Registered Nurse - AI Trainer

Houston, TX · Remote

$55 - $65/hr

Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...

Dane Street, LLC

Certified Professional Coder

Houston, TX · Remote

$21.75 - $29/hr

Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS) Conduct utilization reviews to ... Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We ...

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

... insurance company/third-party payor. Able to work through and accept referrals through various ... Demonstrates understanding of utilization review process to include treatment criteria and ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Houston, TX

Remote Insurance Utilization Review information

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

As of Aug 30, 2026, the average hourly pay for remote insurance utilization review in Houston, TX is $40.38, according to ZipRecruiter salary data. Most workers in this role earn between $31.92 and $46.39 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 Houston, TX?

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

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

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

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

Cities near Houston, 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 Houston, TX as of August 2026, with employment types broken down into 74% Full Time, 21% Part Time, and 5% Contract. Highlights an 5% Hybrid, and 95% Remote job distribution, with an average salary of $83,986 per year, or $40.4 per hour.

Registered Nurse - Utilization Review - RNUR 26-10215

Houston, TX • Remote

Compu-Vision - South
See more jobs at Compu-Vision - Southexternal

$1.9K - $2.1K/wk

Full-time

Posted 4 days ago

Job description

Job Title: Registered Nurse – Utilization Review

Job Location: Fort Myers, FL

Work Arrangement: Remote

Duration: 13 Weeks

Compensation: $1,900–$2,100 Gross Weekly (Based on Experience)

Shift: Day Shift

Schedule:

  • Monday–Friday
  • 8:00 AM – 4:30 PM
  • 40 Hours Per Week

Position Type: Contract

Work Setting: Remote

Position Overview

We are seeking an experienced Registered Nurse (RN) – Utilization Review/Utilization Management for a 13-week remote contract assignment. The RN will review clinical information and medical records to support appropriate levels of care, medical necessity, resource utilization, and positive patient outcomes.

The ideal candidate will have provider-side utilization management experience, strong clinical judgment, excellent computer skills, and hands-on experience with Epic and DragonFly. Candidates must be comfortable working independently in a remote environment while maintaining productivity, accuracy, and quality standards.

Responsibilities
  • Perform utilization review and utilization management activities.
  • Review patient medical records, clinical documentation, and treatment information.
  • Assess medical necessity and appropriateness of level of care.
  • Collaborate with healthcare providers regarding patient care and utilization needs.
  • Communicate effectively with providers and members of the interdisciplinary care team.
  • Utilize DragonFly as the primary utilization management platform.
  • Accurately and promptly document utilization reviews and clinical determinations.
  • Navigate and document within the Epic EMR.
  • Support appropriate resource utilization and optimal patient outcomes.
  • Work independently in a remote environment while meeting productivity and quality expectations.
  • Float to other affiliated campuses as required based on staffing needs; travelers may be expected to float first when coverage is needed.
  • Perform other utilization management duties as assigned.
Required Qualifications Licensure
  • Active Registered Nurse (RN) license required.
Experience
  • Minimum 2 years of relevant nursing experience.
  • Provider-side utilization management experience required.
  • Candidates with exclusively payer-side utilization management experience do not meet the requirement.
  • Previous remote-work experience preferred.
  • Prior travel nursing experience highly preferred.
Technical Skills
  • DragonFly experience required.
  • Epic EMR experience required.
  • Strong computer literacy and clinical documentation skills.
  • Ability to efficiently navigate multiple electronic systems while working remotely.
Certifications
  • CCM or CMCN certification required.
Education
  • Degree accreditation must be verified, or candidate must have at least 5 years of relevant experience.