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Remote Insurance Utilization Review Jobs in Columbia, SC

Amerihealth Caritas

Network Contractor PNM

Columbia, SC · On-site +1

Utilization Review Accreditation Commission (URAC) * Serve as a subject matter expert (SME) on ... Remote; Field Based * Must reside in South Carolina. Will make provider visits throughout the state ...

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All JobsInsurance Utilization Review JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Columbia, SC

Remote Insurance Utilization Review information

See Columbia, SC salary details

$19

$39

$63

How much do remote insurance utilization review jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for remote insurance utilization review in Columbia, SC is $39.12, according to ZipRecruiter salary data. Most workers in this role earn between $30.91 and $44.90 per hour, depending on experience, location, and employer.

What is a remote insurance utilization review?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What skills and qualifications are needed for a remote insurance utilization review specialist?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

What are popular job titles related to Remote Insurance Utilization Review jobs in Columbia, SC?

For Remote Insurance Utilization Review jobs in Columbia, SC, the most frequently searched job titles are:

What job categories do people searching Remote Insurance Utilization Review jobs in Columbia, SC look for?

The top searched job categories for Remote Insurance Utilization Review jobs in Columbia, SC are:

Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Columbia, SC as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $81,362 per year, or $39.1 per hour.

Remote RN Case Management Supervisor

001 BlueCross and BlueShield of South Carolina

Columbia, SC • Remote

Full-time

Posted yesterday

New

Job description

BlueCross BlueShield of South Carolina is seeking a Case Management Supervisor to oversee case management, utilization review, and quality management programs. This remote role includes potential on-site training follow-ups and requires strong leadership, data analysis, and a solid understanding of health insurance operations. The ideal candidate has significant experience in healthcare management and will supervise staff, coordinate program implementation, and drive performance metrics while #J-18808-Ljbffr

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