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Remote Utilization Review Manager Jobs in Houston, TX

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

Minimum of one (1) year experience in utilization review, or utilization management Proficient ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

S. • Minimum of one (1) year experience in utilization review, or utilization management • ... Remote Benefits - Medical , Dental, & Vision. 401K plan Compensation Disclosure The base salary for ...

YO AI Labs

Hospitalist Physician - Remote

Houston, TX · Remote

$70 - $100/hr

Remote Job Overview We are seeking experienced Hospitalist Physicians to contribute their medical ... Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity ...

New

MD Anderson

Financial Clearance Coordinator

Houston, TX · Remote

$42.79 - $53.37/hr

Remote but must be able to come onsite as needed. Why Us. At UT MD Anderson, this role directly ... in utilization review, insurance, case management, or medical clearance. Preferred: 2 years ...

MD Anderson

Financial Clearance Coordinator

Houston, TX · Remote

$42.79 - $53.37/hr

Remote but must be able to come onsite as needed. Why Us? At UT MD Anderson, this role directly ... in utilization review, insurance, case management, or medical clearance. * Preferred: 2 years ...

MD Anderson

Financial Clearance Coordinator

Houston, TX · Remote

$89K/mo

Remote but must be able to come onsite as needed. Why Us? At UT MD Anderson, this role directly ... in utilization review, insurance, case management, or medical clearance. * Preferred: 2 years ...

New

CareVitality Inc

Care Manager - Remote

Houston, TX · Remote

$60K - $77K/yr

Create, review, and update patient-centered care plans based on physical, mental, cognitive ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

Mercor

Registered Nurse - AI Trainer

Houston, TX · Remote

$55 - $65/hr

Remote Role Responsibilities * Review and evaluate AI-generated clinical outputs based on nursing ... Experience reviewing charts for quality improvement, utilization review, CDI, or clinical ...

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Remote Utilization Review Manager information

See Houston, TX salary details

$37.2K

$86.9K

$160K

How much do remote utilization review manager jobs pay per year?

As of Aug 24, 2026, the average yearly pay for remote utilization review manager in Houston, TX is $86,913.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,800.00 and $104,600.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are the most commonly searched types of Remote Utilization Review jobs in Houston, TX?

The most popular types of Remote Utilization Review jobs in Houston, TX are:

What are popular job titles related to Remote Utilization Review Manager jobs in Houston, TX?

For Remote Utilization Review Manager jobs in Houston, TX, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Houston, TX look for?

The top searched job categories for Remote Utilization Review Manager jobs in Houston, TX are:

What cities near Houston, TX are hiring for Remote Utilization Review Manager jobs?

Cities near Houston, TX with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

UR LVN Utilization/Clinical Claim Review Nurse

Pearland, TX

UnitedHealth Group
Insurance Services • 10K+ employees

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 893 rated healthcare providers

Good employer

Recommended by students

Recommended by parents

Learn more about UnitedHealth Groupexternal

$20 - $36/hr

Full-time

Medical, Retirement

Posted 6 days ago

Job description

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40 locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  


The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products.  The UR LVN nurse will serve as facilitator of communication with clinic, payor and other customers.


Primary Responsibilities:

  • Data entry of all UR requests into the Kelsey-Seybold data system
  • Verifies eligibility
  • Obtains benefit interpretation from insurance company
  • Reviews request and chart to determine medical necessity by using internal criteria
  • Approves request or defers to insurance review and assists with MD review
  • Communicates with respective payor to obtain pre-certification authorization
  • Serves as resource to physicians, staff and patients regarding review process
  • Clarifies UR request discrepancies with office submitting or insurance company
  • Other duties as assigned


You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 
 

Required Qualifications:

  • Licensed Vocational Nurse
  • CEU requirement
  • TX LVN license
  • 2 years of utilization review experience at heath plan, ACO, IPA, or provider group OR 3 years of diverse clinical experience, including acute care or similar care
  • Good organization and communication skills
  • HMO, PPO and POS insurance knowledge
  • Valid Driver's license


Preferred Qualifications:

  • Computer and Coding experience


Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.


At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.


OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. 
 

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