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Remote Prior Authorization Rn Jobs in Lexington, SC

CEI

RN/Case Management Coordinator - Remote

Columbia, SC · Remote

$30/hr

Registered Nurse (RN) Care Management Specialist Location: Remote- Onsite for Training (Must reside ... Conduct utilization review and authorization activities to ensure services align with benefit plans ...

CEI

RN/Managed Care Coordinator (Remote

Columbia, SC · Remote

Must have an active, unrestricted RN license in the state of South Carolina Monday-Friday 830-5 Pay ... Performs medical or behavioral review/authorization process. Ensures coverage for appropriate ...

Amerihealth Caritas

Care Manager II

Columbia, SC · On-site +1

This position is a remote field based position in the Richland county area. Must have a BSN RN. ... Prior experience in the Foster Care System, Department of Social Services, or Department of ...

Amerihealth Caritas

Care Manager II

Columbia, SC · On-site +1

This position is a remote field based position in the Richland county area. Must have a BSN RN. ... Prior experience in the Foster Care System, Department of Social Services, or Department of ...

Veterans Health Administration

Practical Nurse

Columbia, SC · On-site +1

$41K - $74K/yr

Appropriately seeks assistance and guidance by informing RN or medical provider of changes in the ... Not Authorized PCS Appraised Value Offer (AVO): Not Authorized Requirements Help Conditions of ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) This position requires a BSN RN with experience in maternity. Required to live within the state of South Carolina with face to face field visits. Areas of ...

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All JobsPrior Authorization Rn JobsRemote Prior Authorization Rn JobsRemote Prior Authorization Rn Jobs in Lexington, SC

Remote Prior Authorization Rn information

See Lexington, SC salary details

$6

$36

$61

How much do remote prior authorization rn jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for remote prior authorization rn in Lexington, SC is $36.16, according to ZipRecruiter salary data. Most workers in this role earn between $26.97 and $42.79 per hour, depending on experience, location, and employer.

What is the difference between Remote Prior Authorization Rn vs Remote Medical Coder?

AspectRemote Prior Authorization RnRemote Medical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), high school diploma or equivalent
Work EnvironmentHealthcare facilities, insurance companies, telehealthMedical offices, insurance companies, remote coding platforms
Industry UsageUtilization review, patient authorization, insurance approvalMedical record review, billing, coding for insurance claims

Remote Prior Authorization Rns focus on reviewing patient information to approve treatments, while Remote Medical Coders translate medical records into codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare industry.

What are popular job titles related to Remote Prior Authorization Rn jobs in Lexington, SC? For Remote Prior Authorization Rn jobs in Lexington, SC, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Rn jobs in Lexington, SC look for? The top searched job categories for Remote Prior Authorization Rn jobs in Lexington, SC are:
What cities near Lexington, SC are hiring for Remote Prior Authorization Rn jobs? Cities near Lexington, SC with the most Remote Prior Authorization Rn job openings:
Remote Prior Authorization Rn jobs near you
Infographic showing various Remote Prior Authorization Rn job openings in Lexington, SC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $75,211 per year, or $36.2 per hour.

RN/Case Management Coordinator - Remote

CEI

Columbia, SC • Remote

$30/hr

Full-time

Posted 12 days ago

Job description

Registered Nurse (RN) Care Management Specialist

Location: Remote- Onsite for Training (Must reside within 2 hours of Columbia, SC)
Pay Rate: $30/hour
Schedule

  • Monday through Friday, 8:30 AM - 5:00 PM
  • Two late shifts per month: 11:30 AM - 8:00 PM
  • No late shifts on Fridays
  • Required onsite training in Columbia, SC during the first week
Required Qualifications
  • Active, unrestricted Registered Nurse (RN) license in South Carolina
  • Minimum of 4 years of recent clinical nursing experience
  • Must live within 2 hours of Columbia, South Carolina
  • Ability to attend onsite training in Columbia during the first week of employment
Position Overview

We are seeking an experienced Registered Nurse (RN) to support members through clinical review, care management, and health advocacy services. This role is responsible for evaluating medical and behavioral health requests, coordinating care, promoting quality outcomes, and ensuring services meet clinical and benefit eligibility requirements.
Key Responsibilities

  • Review and evaluate medical and behavioral health requests for eligibility, benefits, and medical necessity using established clinical guidelines and policies.
  • Assess, plan, coordinate, monitor, and evaluate care for members with chronic, acute, or complex health conditions.
  • Provide active case management, including assessing service needs, developing care plans, coordinating services, and monitoring progress toward member goals.
  • Determine appropriate levels of care, benefits eligibility, length of stay, place of service, and medical necessity for requested services.
  • Maintain accurate and thorough clinical documentation to support medical necessity and benefit determinations.
  • Deliver telephonic care management and health coaching for members with chronic conditions, high-risk pregnancies, and other at-risk health concerns.
  • Utilize motivational interviewing, reflective listening, and behavior-change strategies to improve member engagement and health outcomes.
  • Conduct utilization review and authorization activities to ensure services align with benefit plans and medical necessity criteria.
  • Collaborate with internal teams and refer cases as appropriate to Medical Directors, Case Managers, Preventive Services, Quality Management, and other specialty departments.
  • Support clinical data collection and documentation processes to ensure accurate claims adjudication and reporting.
  • Promote quality, cost-effective healthcare solutions while advocating for members' healthcare needs.
  • Ensure compliance with all applicable regulatory and accreditation standards, including ERISA, NCQA, URAC, Department of Insurance (DOI), and Department of Labor (DOL) requirements.
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