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Remote Utilization Management Nurse Jobs in Texas

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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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How much do remote utilization management nurse jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for remote utilization management nurse in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What is a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

What are the key skills and qualifications needed to thrive as a remote utilization management nurse?

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.

What is the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

More about Remote Utilization Management Nurse jobs

What are the most commonly searched types of Utilization Management Nurse jobs in Texas?

The most popular types of Utilization Management Nurse jobs in Texas are:

What are popular job titles related to Remote Utilization Management Nurse jobs in Texas?

For Remote Utilization Management Nurse jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management Nurse jobs in Texas look for?

The top searched job categories for Remote Utilization Management Nurse jobs in Texas are:

What cities in Texas are hiring for Remote Utilization Management Nurse jobs?

Cities in Texas with the most Remote Utilization Management Nurse job openings:

Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Texas as of August 2026, with employment types broken down into 2% As Needed, 86% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

Utilization Management Rep

Allmed Staffing Inc

Pearland, TX • Remote

Full-time

Medical, Dental, Vision, Retirement

Re-posted 25 days ago

Job description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position Overview

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

  • Collaboration and strong communication
  • Accountability for productivity and quality metrics
  • Continuous learning and process improvement
  • Supportive teamwork across clinical and operational departments
  • Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

  • Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
  • Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
  • Accurately document authorization requests within utilization management systems and/or electronic medical record systems
  • Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
  • Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
  • Maintain accurate records and ensure documentation standards are consistently met
  • Support workflow efficiency while managing multiple priorities in a high-volume environment
  • Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

  • 1–3 years of healthcare experience, preferably within:
    • Utilization Management
    • Insurance operations
    • Medical office environments
    • Managed care settings
  • Experience handling high-volume calls in a professional and efficient manner
  • Strong data entry and documentation skills with high attention to detail
  • Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
  • Strong verbal and written communication skills when interacting with providers, members, and internal teams
  • Basic understanding of healthcare authorization processes and insurance workflows
  • Experience using EMR/EHR platforms, case management systems, or related healthcare systems
  • Strong organizational and time-management skills

Preferred Qualifications

  • Experience supporting authorization processes within healthcare operations or managed care settings
  • Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
  • Experience working with provider communication and care coordination activities
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