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Remote Utilization Review Rn Jobs in Round Rock, TX

YO AI Labs

Pharmacovigilance Expert - Remote

Austin, TX · Remote

$70 - $80/hr

Author and review evaluation tasks based on DSURs, PSURs/PBRERs, safety data, and case-level ... Advanced degree in life sciences, pharmacy, nursing, medicine, or related fields (PharmD, MD, MSc ...

My Face Lady

Austin Aesthetic Injector

Austin, TX · Remote

$102K - $138K/yr

Current, unencumbered NP/PA/RN license in Texas * Aesthetic Training Certification (or willingness ... Review monthly updates and company communications * Treat a minimum of 4 patients per month Ideal ...

Harbor Health

Assistant Counsel

Austin, TX · On-site +1

Description Harbor Health Remote Position - United States POSITION OVERVIEW The Assistant Counsel ... Reporting to the Chief Legal Officer, this role is the primary drafting, reviewing, and negotiating ...

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Remote Utilization Review Rn information

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$19

$39

$64

How much do remote utilization review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for remote utilization review rn in Round Rock, TX is $39.43, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.29 per hour, depending on experience, location, and employer.

What is a remote utilization review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are popular job titles related to Remote Utilization Review Rn jobs in Round Rock, TX?

For Remote Utilization Review Rn jobs in Round Rock, TX, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Round Rock, TX look for?

The top searched job categories for Remote Utilization Review Rn jobs in Round Rock, TX are:

What cities near Round Rock, TX are hiring for Remote Utilization Review Rn jobs?

Cities near Round Rock, TX with the most Remote Utilization Review Rn job openings:

Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Round Rock, TX as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% Remote job distribution, with an average salary of $82,013 per year, or $39.4 per hour.

Appeals Professional III (Monday - Friday)

TMF Health Quality Institute

Austin, TX • On-site, Remote

Full-time

Medical, Retirement

Re-posted 4 days ago

Job description

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
Position Purpose:
Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines.
Essential Responsibilities:
  • Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, and impartial and supports the determination made, and documents review.
  • Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
  • Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
  • Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
  • Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.

Minimum Qualifications
Education
  • Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
    • Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience
  • Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
  • Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
  • Demonstrated experience writing or making medical necessity decisions
  • Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred
  • Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Benefits
C2C offers an excellent benefits package, including:
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement

EOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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