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Work From Home Utilization Review Jobs in Texas (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...

The Jernigan Agency

WORK FROM HOME

Corpus Christi, TX · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales ... Help each client to review their options and apply for that coverage. * See the application through ...

Corvel

Utilization Review Intake Specialist

Irving, TX · Remote

$16.74 - $26.92/hr

Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: * High ... 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening ...

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Work From Home Utilization Review information

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$14

$29

$49

How much do work from home utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for work from home utilization review in Texas is $29.76, according to ZipRecruiter salary data. Most workers in this role earn between $20.82 and $37.84 per hour, depending on experience, location, and employer.

What is a work from home utilization review?

A Work From Home Utilization Review job involves evaluating the necessity, appropriateness, and efficiency of medical services provided to patients, typically for insurance companies or healthcare organizations. Employees in this role review patient records, treatment plans, and medical claims to ensure compliance with established guidelines and standards. Working remotely, these professionals often communicate with healthcare providers, patients, and insurance representatives to gather information and make recommendations regarding coverage or continued care.

What are some common challenges faced by work from home utilization review professionals, and how can they be managed?

Work From Home Utilization Review professionals often face challenges such as maintaining effective communication with healthcare providers and team members, managing time efficiently without in-person supervision, and navigating multiple electronic health record systems remotely. To manage these challenges, it’s important to establish clear communication channels, set structured daily routines, and stay updated with technology training. Many organizations offer virtual team meetings and resources to support remote collaboration and continuous professional development.

What are the key skills and qualifications needed to thrive as a work from home utilization review nurse, and why are they important?

To thrive as a Work From Home Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) are often required. Exceptional communication, critical thinking, and time management skills help in effectively coordinating care and interacting with patients and providers remotely. These skills ensure accurate and efficient reviews, compliance with guidelines, and optimal patient outcomes while working independently.

What is the difference between Work From Home Utilization Review vs Work From Home Medical Coder?

AspectWork From Home Utilization ReviewWork From Home Medical Coder
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical reviewer credentialsRequires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentRemote, often involves reviewing medical records and insurance claimsRemote, involves reviewing and assigning medical codes to patient records
Industry UsageCommon in insurance, healthcare administration, and utilization managementCommon in medical billing, coding, and healthcare documentation

Work From Home Utilization Review and Work From Home Medical Coder roles both operate remotely within the healthcare industry. While utilization reviewers focus on assessing the necessity of medical services, medical coders assign standardized codes to patient records. Both require healthcare-related certifications and are essential for healthcare administration, but they differ in daily tasks and specific credentials.

What are popular job titles related to Work From Home Utilization Review jobs in Texas?

For Work From Home Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Work From Home Utilization Review jobs in Texas look for?

The top searched job categories for Work From Home Utilization Review jobs in Texas are:

What cities in Texas are hiring for Work From Home Utilization Review jobs?

Cities in Texas with the most Work From Home Utilization Review job openings:

Work From Home Utilization Review jobs near you
Infographic showing various Work From Home Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $61,895 per year, or $29.8 per hour.

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Re-posted 22 days ago

Job description

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***

JOB DESCRIPTION:

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

JOB RESPONSIBILITIES:

  • This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
  • Collects clinical and non-clinical data.
  • Verifies eligibility.
  • Determines benefit levels in accordance to contract guidelines.
  • Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.

JOB QUALIFICATIONS (Required):

  • Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.

JOB QUALIFICATIONS (Preferred):

  • MCG or InterQual experience
  • Utilization management experience

LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin Counties).

POSITION: 6-month assignment