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Remote Utilization Management Jobs in Spring, TX

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 ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Spring, TX

Remote Utilization Management information

See Spring, TX salary details

$19

$37

$61

How much do remote utilization management jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for remote utilization management 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 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 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.

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 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 Spring, TX?

The most popular types of Utilization Management jobs in Spring, TX are:

What are popular job titles related to Remote Utilization Management jobs in Spring, TX?

For Remote Utilization Management jobs in Spring, TX, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Spring, TX look for?

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

What cities near Spring, TX are hiring for Remote Utilization Management jobs?

Cities near Spring, TX with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management 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.

Certified Professional Coder

Houston, TX • Remote

Dane Street, LLC
Insurance Actuarial and Claim Adjusting Services • 51 - 200 employees
Learn more about Dane Street, LLCexternal

$21.75 - $29/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Key responsibilities

  • Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS).

  • Conduct utilization reviews to assess medical necessity and documentation compliance.

  • Review medical records and billing for payer disputes, recoupments, and appeals, and prepare detailed audit reports.

Job description

MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES.

We are seeking an experienced CPC-certified medical coder with multi-state experience to perform coding audits, utilization reviews, demand package reviews, and provide litigation support including deposition and testimony services as needed. The ideal candidate must have experience reviewing medical records and billing across multiple states and payer environments.

Responsibilities:

Perform comprehensive medical coding audits (ICD-10-CM, CPT, HCPCS)

Conduct utilization reviews to assess medical necessity and documentation compliance

Review the medical portion and prepare the billing and coding review portion of demand package reviews for personal injury and insurance cases

Analyze medical records for payer disputes, recoupments, and appeals

Prepare detailed, defensible written audit reports

Provide expert review, affidavit support, deposition preparation, and testimony when required

Interpret CMS guidelines, LCD/NCD policies, and state-specific Medicaid and commercial payer rules

Review E/M services under 2021+ guidelines

Identify compliance risks and documentation deficiencies

Requirements

  • Active CPC certification through the American Academy of Professional Coders (AAPC)
  • CPMA strongly preferred
  • Minimum 5-7 years of professional coding experience
  • Documented experience performing audits or utilization reviews in multiple states
  • Strong knowledge of CMS regulations and state Medicaid variations
  • Experience with Medicare, Medicare Advantage, and commercial payer audits
  • Prior demand package review or litigation support experience required
  • Deposition and/or expert testimony history preferred
  • Excellent written reporting and analytical skills
  • Ability to work independently and meet strict deadlines
  • Preferred Experience:
  • RAC, UPIC, or commercial payer audit response
  • Multi-state Medicaid policy interpretation
  • Expert witness experience in civil litigation
  • Data analysis and audit trend reporting
  • This position may be structured as part time Candidates must be comfortable reviewing policies and payer rules across multiple jurisdictions and is able to do multiple types of reviews/audits

Benefits

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace. 

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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