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Remote Utilization Review Jobs in Houston, TX (NOW HIRING)

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How much do remote utilization review jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote utilization review in Houston, TX is $40.38, according to ZipRecruiter salary data. Most workers in this role earn between $31.92 and $46.39 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 Houston, TX?

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

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

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

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

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

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

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

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Houston, TX as of August 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 100% Remote job distribution, with an average salary of $83,986 per year, or $40.4 per hour.

Clinical Admin Coordinator

Allmed Staffing Inc

Pearland, TX • Remote

$13.50/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 8 days ago

Job description

Referral Navigator Representative

Job Type: Full-Time / Remote
Work Location: Remote
Schedule: 8:00 AM–7:00 PM scheduling window; specific shift assigned based on business needs
Contract: 08/17/2026 to 12/31/2026
Pay Rate: $13.50/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance and 401(k)
Interview Process: One video interview

Position Overview

We are seeking a Referral Navigator Representative to support authorization and referral operations in a remote healthcare environment. This position is responsible for coordinating fax-based documentation and supporting the authorization process to ensure referrals and prior authorization requests are processed accurately, efficiently, and within established timelines.

The ideal candidate will have experience in healthcare administration, prior authorizations, referrals, or health plan operations, with a strong understanding of payer requirements and healthcare workflows.

Key Responsibilities

  • Coordinate incoming and outgoing faxes related to referrals and prior authorizations.
  • Review referral and authorization documentation for completeness and accuracy.
  • Process and route documentation to the appropriate departments, providers, or health plan representatives.
  • Track authorization and referral requests and follow up on outstanding documentation.
  • Work with provider offices, insurance plans, and internal teams to obtain required information.
  • Ensure requests are processed according to established payer guidelines and turnaround times.
  • Maintain accurate records and documentation within applicable systems.
  • Identify missing or incomplete information and take appropriate action to resolve issues.
  • Protect confidential patient information and maintain compliance with HIPAA and applicable healthcare regulations.
  • Support utilization management and authorization workflows as assigned.

Required Qualifications

  • 2–4+ years of experience in prior authorization processing, referral coordination, healthcare administration, or healthcare operations.
  • Knowledge of insurance plans, payer guidelines, and authorization requirements.
  • Understanding of basic medical terminology.
  • Strong attention to detail and organizational skills.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple tasks and prioritize work in a fast-paced environment.
  • Strong computer skills and ability to navigate multiple systems.
  • Ability to work independently in a remote environment.

Preferred Qualifications

  • Experience working with managed care organizations, health plans, or provider offices.
  • Familiarity with utilization management workflows.
  • Experience with compliance standards and audit processes.
  • Previous experience coordinating referrals and authorizations through fax-based workflows.

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