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Manager Utilization Management Jobs in Charleston, SC

Pharmacy Careers

Formulary Management Pharmacist

Charleston, SC · On-site

$54.50 - $65.50/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

Global Force

Care Connector

North Charleston, SC · On-site

North Charleston- SC 29405 Contract role for 3 months with possibility of extension The Care Connector is responsible for supporting the daily operations of integrated care management and utilization ...

Tristar Insurance

Telephonic Medical Case Manager

SC · On-site +1

$85K - $92K/yr

Knowledge of utilization management, quality improvement, discharge planning, and or cost management. * Ability to solve practical problems and deal with a variety of variables. * Possess planning ...

Zunch Staffing

Director Case Management

Charleston, SC · On-site

$102K - $153K/yr

... utilization. The Director is responsible for daily operations, achieving outcomes, and engaging ... Oversee core case management functions and practices. * Ensure adherence to care coordination and ...

ARD Logistics

Site Manager

Charleston, SC · On-site

Make recommendations to senior management on programs to improve operations. Layout Develop a space utilization plan to meet prescribed cost and service standards. Monitor the space layout plan to ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Charleston, SC

Manager Utilization Management information

See Charleston, SC salary details

$36.5K

$85.2K

$156.8K

How much do manager utilization management jobs pay per year?

As of Aug 19, 2026, the average yearly pay for manager utilization management in Charleston, SC is $85,170.00, according to ZipRecruiter salary data. Most workers in this role earn between $55,700.00 and $102,500.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Charleston, SC?

The most popular types of Utilization Management jobs in Charleston, SC are:

What are popular job titles related to Manager Utilization Management jobs in Charleston, SC?

For Manager Utilization Management jobs in Charleston, SC, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Charleston, SC look for?

The top searched job categories for Manager Utilization Management jobs in Charleston, SC are:

What cities near Charleston, SC are hiring for Manager Utilization Management jobs?

Cities near Charleston, SC with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Charleston, SC as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution, with an average salary of $85,170 per year, or $40.9 per hour.

Utilization Review Nurse

Careers Integrated Resources Inc

North Charleston, SC • On-site

Other

Posted 7 days ago

Job description

Utilization Review Nurse

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description

• Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services

• Applying criteria to inpatient admissions and performing concurrent review functions, identifying discharge planning needs and referral of members to case management.

• Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines

• Utilizes clinical information to determine if criteria for medical necessity and benefit guidelines are met

Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision

• Documents all pertinent case information and dispositions for approvals and denials

• Refers all cases failing to meet interqual medical necessity criteria to Medical Director for review and final determination

• Communicates with providers to initiate/coordinate outpatient services/discharge planning needs for members

• Acts as a liaison to assure services are provided in the least restrictive, most cost effective and clinically appropriate setting

• Works with the Utilization Management Manager, the Medical Director and providers to ensure that complete medical information is available to allow utilization management decisions to be made within The Plan's standards for decision making

• Identifies potential members who may benefit from case management services and facilitates referral to the program

• Identifies and resolves any problems that could interfere with provider's continuity and coordination of care of members and refers unresolved problems to Manager

• Creates and maintains monthly reports on inpatient activities

• Performs other related duties and projects as assigned

• Adheres to ACFC policies and procedures

• Supports and carries out our Mission & Values.

Qualifications

• Associates RN degree required, Bachelor's degree preferred

• Two years of experience in managed care quality assurance or utilization review

• RN must have two years of experience in an acute care hospital.

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