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Remote Utilization Management Jobs in Texas (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Katy, TX · On-site +1

$49.50 - $60.25/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Katy, TX · On-site +1

$52.50 - $64/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Curative HR LLC

Specialty UM Pharmacist

Austin, TX · Remote

SUMMARY This role is primarily responsible for utilization management activities related to ... This is a REMOTE Position with RPh Licensure required in the state of residence. ESSENTIAL DUTIES ...

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Remote Utilization Management information

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$39

$64

How much do remote utilization management jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for remote utilization management 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.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

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

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Texas? The most popular types of Utilization Management jobs in Texas are:
What are popular job titles related to Remote Utilization Management jobs in Texas? For Remote Utilization Management jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Texas look for? The top searched job categories for Remote Utilization Management jobs in Texas are:
What cities in Texas are hiring for Remote Utilization Management jobs? Cities in Texas with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Utilization Management Nurse (84124)

Utilization Management Nurse (84124)

Regency Integrated Health Services

Austin, TX • Remote

Full-time

Posted 13 days ago

Job description

Primary Responsibilities

The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.

Essential Functions

Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.

Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.

Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member's health need.

Location Requirements

This position is remote but requires the employee to live within our service area, which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.

Educational/Training Requirements

  • Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience.
  • Payor Utilization Management: 3 years recommended experience
  • Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
  • Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.

Licensing Requirements

  • Current unencumbered LVN or RN license in Texas or compact license.

Experience Requirements

  • 2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
  • UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side. 
  • 5+ years of acute clinical experience.
  • The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Regency Integrated Health Services logo

About Regency Integrated Health Services

Sourced by ZipRecruiter

Regency Integrated Health Services, located in Victoria, Texas, U.S., is a healthcare provider operating within post-acute healthcare and rehabilitation industry sector. As a well-known name in the industry with an official website at regencyhealthcare.com, the company specializes in offering a wide range of health services which primarily include skilled nursing, rehabilitation, long-term care, and assisted living services. Since its inception, Regency Integrated Health Services has been committed to providing the highest possible standards in healthcare.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Victoria, TX, US

Year founded

2015

Social media

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