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Remote Utilization Management Nurse Jobs in Spring, TX

Aveanna Healthcare

Payor Relations Manager

Houston, TX · On-site +1

Essential Job Functions Develop and own relationships with all case management and utilization ... with Private Duty Nursing utilization request processes Proven sales track record Extensive ...

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

Minimum of two (2) years experience in utilization review, case management, or clinical quality ... 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] ...

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Remote Utilization Management Nurse information

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$37

$61

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

As of Sep 11, 2026, the average hourly pay for remote utilization management nurse in Spring, TX is $37.63, according to ZipRecruiter salary data. Most workers in this role earn between $29.71 and $43.22 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.

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The top searched job categories for Remote Utilization Management Nurse jobs in Spring, TX are:

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Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Spring, TX as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $78,263 per year, or $37.6 per hour.

Sr. Engineer (FHIR Integration)

Houston, TX • Remote

Resource Consultings Services Inc
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Resource Consultings Services Incexternal

Contractor

Re-posted 15 days ago

Job description

Role: Senior Engineer (FHIR Integration)

Location: Remote

Duration: 6+ month

Job Description

  • Design, develop, and implement Da Vinci FHIR solutions supporting CMS-0057-F compliance, including Coverage Requirements Discovery (CRD), Documentation Templates & Rules (DTR), and Prior Authorization Support (PAS) APIs.
  • Build and deploy production-ready APIs leveraging FHIR R4 standards and best practices for healthcare interoperability.
  • Design and implement integrations between payer systems, utilization management platforms, provider portals, and enterprise healthcare applications.
  • Develop and maintain RESTful APIs and integration services connecting claims, benefits, authorization, and provider-facing systems.
  • Architect scalable, highly available backend services capable of supporting real-time point-of-care authorization and eligibility workflows.
  • Define service boundaries, API contracts, and integration patterns across enterprise healthcare platforms.
  • Collaborate with architects, product owners, business stakeholders, and engineering teams to deliver secure, compliant, and scalable healthcare solutions.
  • Ensure solutions meet regulatory, performance, security, and reliability requirements for production healthcare environments.
  • Participate in architecture reviews, code reviews, and technical leadership activities while mentoring development teams.

Qualifications Required:

  • Extensive experience implementing Da Vinci FHIR implementation guides, including CRD, DTR, and PAS.
  • Own the technical design of a multi-API build (CRD, DTR, PAS) sharing a common decision engine and pre-screener: defining service boundaries, integration patterns across claims/benefits, real-time point-of-order requests route into shared backend logic.
  • Proven hands-on experience developing against FHIR R4 standards in production environments.
  • Strong experience integrating payer platforms with claims, benefits, utilization management (UM), and provider-facing systems.
  • Experience supporting CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) initiatives.
  • Knowledge of healthcare authorization, claims processing, utilization management, and payer workflows.
  • Able to own REST wrapper and endpoint integration work end-to-end.
  • Experience integrating with platforms such as Facets, Zyter TruCare, Availity, ProAuth, or comparable healthcare payer technologies.
  • Expertise designing and developing RESTful APIs, microservices, and enterprise integration solutions.
  • Strong background in API architecture, distributed systems, and service-oriented design.
  • Experience designing high-availability, scalable systems supporting mission-critical healthcare applications.
  • Strong understanding of healthcare interoperability standards, API security, OAuth 2.0, SMART on FHIR, and HIPAA compliance.

Additional Information

  • Participation in both internal meetings and external meetings via video calls, as necessary.
  • Ability to go into corporate or client offices to work onsite, as necessary.
  • Prolonged periods of remaining stationary at a desk and working on a computer, as necessary.
  • Ability to bend, kneel, crouch, and reach overhead, as necessary.
  • Hand-eye coordination necessary to operate computers and various pieces of office equipment, as necessary.
  • Vision abilities including close vision, toleration of fluorescent lighting, and adjusting focus, as necessary.
  • For positions that require business travel and/or event attendance, ability to lift 25 lbs, as necessary.
  • For positions that require business travel and/or event attendance, a valid driver’s license and acceptable driving record are required, as driving is an essential job function.