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Remote Utilization Management Jobs in Texas (NOW HIRING)

MRIoA

Oral Surgery

Dallas, TX · On-site +1

$299K - $395K/yr

... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no minimum ...

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Oscar Health

Sr. Quality of Care Review Nurse

Dallas, TX · Remote

$83K - $109K/yr

You will report into the Nurse Manager, Quality of Care. Work Location: This is a remote position ... Health plan utilization management experience or case management experience. * Experience in health ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Texas

Remote Utilization Management information

See Texas salary details

$19

$39

$64

How much do remote utilization management jobs pay per hour?

As of Aug 9, 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 in remote utilization management?

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
Infographic showing various Remote Utilization Management job openings in Texas as of August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

Supervisory Medical Director, National Physical Health Appeals Outpatient UM

Centene

Carlton, TX • On-site, Remote

$236K - $449K/yr

Full-time

Medical, Retirement, PTO

Posted 2 days ago

New

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 402 frontline employees who took The Breakroom Quiz

24th of 887 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Supervisory Medical Director at Centene provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. This role further assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives.

  • Provides operational leadership, coaching and mentorship for a team of front-line medical directors including, but not limited to, scheduling for Utilization Management coverage, annual performance goal development, routine 1:1s, mentorship/career development, and annual evaluations.
  • Participates in creation and updates to new hire and existing medical director training, including new hire mentorship.
  • Supports Chief Medical Officer and Sr. Medical Director in the execution of strategic clinical initiatives.
  • Participates in utilization review studies, performance management and trend analysis.
  • Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.
  • Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints.
  • Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements.
  • Provides clinical guidance and training to appeals medical director team around regulatory updates.
  • Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience:

  • Medical Doctor (MD) Graduate of an accredited medical school required
  • Master's Degree MBA, MPH, or epidemiologist degree preferred
  • 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
  • 1+ years Supervisory/management experience preferred
  • Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services required
  • American Board Certification in Internal or Family Medicine, preferred.
  • MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required


Pay Range: $236,500.00 - $449,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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