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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 ...

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] ...

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 ...

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 ...

CareVitality Inc

Care Manager - Remote

Houston, TX · Remote

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 ...

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 ...

New

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

... the Utilization Management team for concurrent reviews. * Demonstrates an ability to be flexible, organized and function well in stressful situations. * Treats patients and their families with ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Houston, TX

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 28, 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

Registered Nurse - Utilization Review - RNUR 26-10215

Houston, TX • Remote

Compu-Vision - South
See more jobs at Compu-Vision - Southexternal

$1.9K - $2.1K/wk

Full-time

Posted yesterday

New

Job description

Job Title: Registered Nurse – Utilization Review

Job Location: Fort Myers, FL

Work Arrangement: Remote

Duration: 13 Weeks

Compensation: $1,900–$2,100 Gross Weekly (Based on Experience)

Shift: Day Shift

Schedule:

  • Monday–Friday
  • 8:00 AM – 4:30 PM
  • 40 Hours Per Week

Position Type: Contract

Work Setting: Remote

Position Overview

We are seeking an experienced Registered Nurse (RN) – Utilization Review/Utilization Management for a 13-week remote contract assignment. The RN will review clinical information and medical records to support appropriate levels of care, medical necessity, resource utilization, and positive patient outcomes.

The ideal candidate will have provider-side utilization management experience, strong clinical judgment, excellent computer skills, and hands-on experience with Epic and DragonFly. Candidates must be comfortable working independently in a remote environment while maintaining productivity, accuracy, and quality standards.

Responsibilities
  • Perform utilization review and utilization management activities.
  • Review patient medical records, clinical documentation, and treatment information.
  • Assess medical necessity and appropriateness of level of care.
  • Collaborate with healthcare providers regarding patient care and utilization needs.
  • Communicate effectively with providers and members of the interdisciplinary care team.
  • Utilize DragonFly as the primary utilization management platform.
  • Accurately and promptly document utilization reviews and clinical determinations.
  • Navigate and document within the Epic EMR.
  • Support appropriate resource utilization and optimal patient outcomes.
  • Work independently in a remote environment while meeting productivity and quality expectations.
  • Float to other affiliated campuses as required based on staffing needs; travelers may be expected to float first when coverage is needed.
  • Perform other utilization management duties as assigned.
Required Qualifications Licensure
  • Active Registered Nurse (RN) license required.
Experience
  • Minimum 2 years of relevant nursing experience.
  • Provider-side utilization management experience required.
  • Candidates with exclusively payer-side utilization management experience do not meet the requirement.
  • Previous remote-work experience preferred.
  • Prior travel nursing experience highly preferred.
Technical Skills
  • DragonFly experience required.
  • Epic EMR experience required.
  • Strong computer literacy and clinical documentation skills.
  • Ability to efficiently navigate multiple electronic systems while working remotely.
Certifications
  • CCM or CMCN certification required.
Education
  • Degree accreditation must be verified, or candidate must have at least 5 years of relevant experience.