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Remote Optum 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

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 ...

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 ...

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 ...

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 ... Support peer-to-peer engagement activities related to authorization and utilization review ...

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 ... Apple equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast ...

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

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Remote Optum Utilization Review information

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

As of Aug 30, 2026, the average hourly pay for remote optum 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 Optum Utilization Review?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review nurse?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

What are the most commonly searched types of Optum Utilization Review jobs in Houston, TX?

The most popular types of Optum Utilization Review jobs in Houston, TX are:

What are popular job titles related to Remote Optum Utilization Review jobs in Houston, TX?

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

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

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

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

Cities near Houston, TX with the most Remote Optum Utilization Review job openings:

Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Houston, 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 $83,986 per year, or $40.4 per hour.

Registered Nurse - Utilization Review - RNUR 26-10215

Compu-Vision - South

Houston, TX • Remote

$1.9K - $2.1K/wk

Full-time

Posted 3 days ago

New

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.