Remote Utilization Review Rn Jobs in Houston, TX

The University of Texas MD Anderson Cancer Center is a leading institution focused on cancer care, research, education, and prevention. The Financial Clearance Center supports patients, providers, and payors by facilitating financial clearance activities, insurance verification, authorization management, financial counseling, and clinical documentation review to help ensure timely access to care. The Financial Clearance Coordinator plays a critical role in coordinating clinical and financial clearance processes while supporting patients throughout their care journey.

As part of UT MD Anderson, the Financial Clearance Coordinator applies clinical expertise and sound judgment to support medical necessity reviews, authorization activities, peer-to-peer engagement, and financial counseling. The Financial Clearance Coordinator collaborates with patient access teams, payors, third-party vendors, and clinical staff to resolve barriers to care. The Financial Clearance Coordinator helps ensure timely and accurate financial clearance while contributing to the organization's mission of exceptional patient care.

The ideal candidate has an accredited nursing education, oncology nursing experience, utilization review experience with external payors, and strong knowledge of healthcare authorizations and reimbursement processes. Preferred qualifications include research and clinical trial knowledge, authorization experience, and professional certifications such as Certified Case Manager, Certified Healthcare Access Manager, Advanced Cardiac Life Support, or Pediatric Advanced Life Support. Salary Range (Annual): Minimum $89,000.00 - Midpoint $111,000.00 - Maximum $133,000.00 Hourly Equivalent (40-hour work week): Minimum $42.79 - Midpoint $53.37 - Maximum $63.94 Work Schedule: Monday - Friday 8am - 5pm

Work Location: Remote but must be able to come onsite as needed. Why Us. At UT MD Anderson, this role directly supports the organization's mission by helping patients navigate complex insurance and authorization requirements that enable timely access to life-saving cancer care.

The position offers opportunities to leverage clinical expertise, collaborate with multidisciplinary teams, contribute to operational excellence, and grow professionally within a nationally recognized healthcare environment while maintaining a focus on patient-centered service. Employer-paid medical coverage starting day one for employees working 30+ hours/week, plus optional group dental, vision, life, AD&D, and disability insurance. Accruals for PTO and Extended Illness Bank, plus paid holidays, wellness, childcare, and other leave options.

Tuition Assistance Program after six months of service and access to extensive wellness, fitness, and employee resource groups. Defined-benefit pension through the Teachers Retirement System, voluntary retirement plans, and employer-paid life and reduced salary protection programs. Responsibilities Documentation & Authorization Processing Obtain and document verification of patient eligibility and applicable effective dates using institutional systems, payor systems, web portals, and available tools within established departmental timeframes.

Notify Patient Access and patients when eligibility information is invalid or cannot be verified. Obtain and document verification of patient benefits, including product type, network status, co-payments, deductibles, co-insurance amounts, pre-existing condition indicators, and lifetime or annual maximums. Enter accurate eligibility and benefits information into the electronic health record in a timely manner.

Manage worklists for cases requiring pre-authorization and coordinate directly with payors or assigned third-party vendors. Obtain required pre-authorizations through online portals and available authorization tools whenever possible. Accurately document authorization numbers, reference numbers, payor contacts, and authorization outcomes in the electronic health record.

Maintain complete and accurate documentation of all communications with patients, payors, vendors, Patient Access personnel, and other stakeholders. Clinical Review & Medical Necessity Support Apply clinical knowledge and professional judgment to support pre-authorization activities. Assist associates when clinical interpretation, medical necessity justification, and clinical review are required.

Support peer-to-peer engagement activities related to authorization and utilization review processes. Assess and interpret patients' clinical conditions to facilitate timely resolution of financial clearance issues. Stay current with appropriate clinical documentation requirements and professional publications.

Clinical Trial & Coverage Review Review clinical trial participation details and identify services covered by trial sponsors. Document services designated for sponsor coverage and those designated for patient insurance coverage. Communicate coverage responsibilities appropriately with patients and payors.

Ensure accurate documentation of clinical trial-related financial clearance activities. Financial Counseling & Customer Collaboration Provide financial counseling to patients regarding estimated costs and expected financial responsibility. Assist with calculating patient liability including co-payments, deductibles, and co-insurance obligations.

Discuss payment requirements, available payment plan options, and patient financial assistance opportunities when applicable. Review Advance Beneficiary Notices (ABN), Medicare Secondary Payer Questionnaires (MSPQ), account status, and financial clearance barriers with patients. Collaborate with Patient Access to document updated or corrected insurance information according to departmental policies and procedures.

Answer emails and phone calls promptly and respond to voicemails and in-basket messages within one business day. Maintain professional and courteous relationships with patients, physicians, payors, vendors, and business partners. Operational Excellence & Professional Development Promptly escalate financial clearance or counseling issues to the Financial Clearance Supervisor when appropriate.

Seek assistance from Financial Clearance Coordinators when additional support is needed. Complete and submit required documents, including PFA and COBRA-related documentation, requiring supervisor approval. Participate in educational, training, and mentoring opportunities to enhance performance and professional growth.

Perform all other duties as assigned. EDUCATION Required: Graduation from an accredited school of nursing. WORK EXPERIENCE Required: Two years experience in nursing, or one year related nursing experience in utilization review, insurance, case management, or medical clearance.

Preferred: 2 years Oncology nursing experience. and Preferred: 2 years Experience in utilization review with external payors within a hospital or insurance setting. Preferred: Research, clinical trial knowledge, and authorization experience.

LICENSES AND CERTIFICATIONS Required: RN - Registered Nurse - State Licensure State of Texas Professional Nursing license (RN). Upon Hire and Required: BLS - Basic Life Support Upon Hire or Required: CPR - Cardiac Pulmonary Resuscitation Upon Hire Preferred: CCM - Certified Case Manager Commission for Case Manager Certification. Upon Hire Preferred: CHAM - Certified Healthcare Access Manager National Association of Healthcare Access Management.

Upon Hire Preferred: ACLS - Advanced Cardiac Life Support Certification as required by patient care area. Upon Hire Preferred: PALS - Pediatric Advanced Life Support Certification as required by patient care area. Upon Hire The University of Texas MD Anderson Cancer Center offers excellent benefits, including medical, dental, paid time off, retirement, tuition benefits, educational opportunities, and individual and team recognition.

This position may be responsible for maintaining the security and integrity of critical infrastructure, as defined in Section 113.001(2) of the Texas Business and Commerce Code and therefore may require routine reviews and screening. The ability to satisfy and maintain all requirements necessary to ensure the continued security and integrity of such infrastructure is a condition of hire and continued employment. It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state, or local laws unless such distinction is required by law.http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html Additional Information Requisition ID: 182504 Employment Status: Full-Time Employee Status: Regular Work Week: Days Minimum Salary: US Dollar (USD) 89,000 Midpoint Salary: US Dollar (USD) 111,000 Maximum Salary : US Dollar (USD) 133,000 FLSA: exempt and not eligible for overtime pay Fund Type: Hard Work Location: Remote (within Texas only) Pivotal Position: No Referral Bonus Available?: No Relocation Assistance Available?: No #LI-Remote Apply