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Prisma Health Utilization Management Jobs (NOW HIRING)

Prisma Health

Physician - EM - Columbia

Columbia, SC · On-site

Participates in the establishment of quality assurance programs, utilization management programs ... Job will be considered a member of management staff at Prisma Health Company or affiliate and will ...

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Prisma Health Utilization Management information

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$39K

$89.5K

$163K

How much do prisma health utilization management jobs pay per year?

As of Jun 10, 2026, the average yearly pay for prisma health utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is the difference between Prisma Health Utilization Management vs Prisma Health Case Management?

AspectPrisma Health Utilization ManagementPrisma Health Case Management
Primary FocusReviewing medical necessity and approving or denying servicesCoordinating patient care and discharge planning
CredentialsRN, licensed healthcare professionalsRN, social worker, or licensed counselor
Work EnvironmentInsurance review departments, hospital settingsHospitals, outpatient clinics, community health settings
Employer UsageInsurance companies, health systemsHospitals, health systems, community agencies

Prisma Health Utilization Management primarily involves reviewing and authorizing healthcare services based on medical necessity, while Prisma Health Case Management focuses on coordinating patient care and discharge planning. Both roles require healthcare credentials and work within healthcare or insurance environments, but their core responsibilities differ significantly.

What is Prisma Health Utilization Management?

Prisma Health Utilization Management is a department within Prisma Health that evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. The team works to ensure that care is evidence-based and meets established guidelines, while also optimizing resource use and controlling healthcare costs. Utilization management professionals collaborate with healthcare providers, insurance companies, and patients to review treatment plans and manage hospital stays, authorizations, and appeals.

What are some typical challenges faced by Utilization Management professionals at Prisma Health, and how can they be addressed?

Utilization Management professionals at Prisma Health often encounter challenges such as coordinating care efficiently across departments, staying updated with evolving insurance requirements, and balancing patient advocacy with cost management. To address these, team members benefit from robust communication skills, ongoing training on payer policies, and regular collaboration with clinical teams. Leveraging established protocols and decision-support tools also helps streamline the review process and ensures compliance with both internal and external standards.

What are the key skills and qualifications needed to thrive in Utilization Management at Prisma Health, and why are they important?

To thrive in Utilization Management at Prisma Health, you need a background in nursing or healthcare, knowledge of medical necessity criteria, and experience in care coordination, often supported by RN licensure or relevant clinical degrees. Familiarity with case management software, electronic medical records (EMRs), and utilization review tools is commonly required. Strong analytical thinking, communication, and negotiation skills help professionals collaborate with providers and insurance companies. These abilities are vital to ensure patients receive appropriate, cost-effective care while maintaining compliance with regulatory and organizational standards.
Infographic showing various Prisma Health Utilization Management job openings in the United States as of June 2026, with employment types broken down into 69% Full Time, and 31% Part Time. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Physician- Women's Mental Health Fellow

Physician- Women's Mental Health Fellow

Prisma Health

Greenville, SC • On-site

Full-time

Posted 21 days ago

Prisma Health rating

7.0

Company rating: 7.0 out of 10

Based on 336 frontline employees who took The Breakroom Quiz

405th of 870 rated healthcare providers

Job description

Inspire health. Serve with compassion. Be the difference.
Job Summary
The Prisma Health Physician is responsible for the provision of quality medical services to patients of Prisma Health-University Medical Group
Accountabilities
  • Engages in the diagnosis, prevention, or treatment of disease, defects or injuries and recommend or prescribe treatments for the relief or cure of physical, mental or functional ailments or defects.
  • Renders medical treatment to his or her patients consistent with generally accepted professional standards of care without regard to their ability to pay for such treatment and without regard to race, creed, color, sex, religion, national origin, or age.
  • Completes accurate, legible, and timely records with respect to all medical examinations and procedures; to accurately use Current Procedural Terminology and International Classification of Diseases codes.
  • Provides after hours call coverage equally with other physicians of the Practice unless there is an agreement otherwise.
  • Complies with standards of accepted medical practice, the rules and regulations of managed care organizations and other payors, including but not limited to Medicare and Medicaid (except to the extent those rules conflict with Physician's professional medical judgment), and the standards of the Joint Commission on Accreditation of Healthcare Organizations.
  • Enhances clinical skills by maintaining sufficient continuing medical education to meet the requirements of the Physician's certification and/or state licensing board.
  • Agrees to actively participate in non-revenue generating activities which serve to advance the Vision and Mission of Prisma Health. As an Academic Health Center, these activities may range from serving on committees, community outreach, helping to meet the teaching, the research goals and/or other activities as determined by the appropriate Department Chair. These important expectations are shared by all providers within Prisma Health-University Medical Group and are key elements of a high performing, integrated, physician led organization.
  • Participates in responding to requests for proposals for managed care contracts.
  • Participates in the establishment of quality assurance programs, utilization management programs, patient education services, and patient satisfaction programs.
  • Assists Employer in obtaining and maintaining any and all licenses, permits and other authorizations, plus achieving any applicable accreditation standards that relate to the business of Physician's Practice or Department.

Supervisory/Management Responsibility
This is a non-management job that will report to a supervisor, manager, director, or executive.
Minimum Requirements
  • Doctor of Medicine or Doctor of Osteopathic Medicine
  • Successful Completion of Residency; Board Certified or Board Eligible; Medical Staff Privileges

Required Certifications/Registrations/Licenses
  • Must be licensed to practice medicine in the state of employment
  • Controlled Substance License in state of employment
  • Drug Enforcement Agency Number

Other Required Skills and Experience
  • Basic Computer Skills
  • Knowledge of Office Equipment (fax/copier)
  • Mathematical skills
  • Specialty specific skills

Work Shift
Day (United States of America)
Location
Greenville Memorial Med Campus
Facility
2121 Psychiatry OP - Patewood
Department
21211000 Psychiatry OP - Patewood-Practice Operations
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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