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Remote Utilization Review Jobs in Texas (NOW HIRING)

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 ...

SUN Behavioral Houston

Remote Intake Coordinator

Houston, TX · On-site +1

$17.25 - $23.50/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

WNS Global Services

Sr Nurse - Clin. Education

Houston, TX · Remote

$80K - $95K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Conducts training for staff members pertaining to Utilization Review process, clinical rules ... Remote education/training experience a plus Ability to flex work hours based on business needs ...

WNS Global Services

Sr Nurse - Clin. Education

Houston, TX · On-site +1

$80K - $95K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... pertaining to Utilization Review process, clinical rules/guidelines, client/module/modality ... • Remote education/training experience a plus • Ability to flex work hours based on business ...

Corvel

Payment Integrity Analyst II

Fort Worth, TX · Remote

$66K - $101K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Reviews, analyzes, and ... Prospective, concurrent and retrospective utilization review * 1+ years healthcare revenue cycle ...

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 ...

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Showing results 21-40

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Texas

Remote Utilization Review information

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$19

$39

$64

How much do remote utilization review jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for remote utilization review in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What are the most commonly searched types of Utilization Review jobs in Texas?

The most popular types of Utilization Review jobs in Texas are:

What are popular job titles related to Remote Utilization Review jobs in Texas?

For Remote Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Texas look for?

The top searched job categories for Remote Utilization Review jobs in Texas are:

What cities in Texas are hiring for Remote Utilization Review jobs?

Cities in Texas with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

Medical Director Utilization Management Oncology

The Oncology Institute of Hope and Innovation

Dallas, TX • Remote

$275K - $325K/yr

Full-time

Posted 26 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.

 Key Responsibilities:

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
  • Partner with clinical and operational teams to support value-based care.
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.

Qualifications:

  • Medical degree (MD or DO)
  • Board Certification in Oncology.
  • Minimum of 5 years of clinical experience in oncology.
  • 2+ years of Utilization Management experience
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$275,000—$325,000 USD