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Remote Utilization Management Nurse Jobs in Greer, SC

Abbott

Implementation Project Manager

Greenville, SC · Remote

The Opportunity This position is a remote based position for in the Abbott Point of Care ... Facilitate project management of the Implementation and Integration of customer point of care ...

Abbott

Implementation Project Manager

Greenville, SC · Remote

The Opportunity This position is a remote based position for in the Abbott Point of Care ... Facilitate project management of the Implementation and Integration of customer point of care ...

Sedgwick

RN Field Case Manager

Spartanburg, SC · On-site +1

$76K - $96K/yr

Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face-to-face interaction with injured workers and medical ...

York Risk Services

RN Field Case Manager

Spartanburg, SC · On-site +1

$76K - $96K/yr

Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management ... remote work environment that allows face-to-face interaction with injured workers and medical ...

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How much do remote utilization management nurse jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for remote utilization management nurse in Greer, SC is $40.65, according to ZipRecruiter salary data. Most workers in this role earn between $32.12 and $46.68 per hour, depending on experience, location, and employer.

What is a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

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

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.

What is the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

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Remote Utilization Management Nurse jobs near you

Medical Management Coordinator (Remote)

Spartanburg Regional Healthcare System

Spartanburg, SC • Remote

Full-time

Posted 2 days ago

New

Spartanburg Regional Healthcare System rating

6.7

Company rating: 6.7 out of 10

Based on 117 frontline employees who took The Breakroom Quiz

532nd of 894 rated healthcare providers

Job description

Job Requirements

Position Summary

The Medical Management Coordinator coordinates all utilization management, and case management activities for the Spartanburg Regional Healthcare System group. The position provides support function to the RHP Medical Management Committee. Must meet productivity standards, complete work in a timely manner. Must be flexible and adapt to changes in the work environment; manage competing demands; change the approach or method to best fit the situation; be able to cope with delay or unexpected events. Take responsibility; keep commitments; complete tasks on time. Volunteer readily; take independent actions; ask for and offer help when needed.

* Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin.

Minimum Requirements

Education           

  • Registered Nurse

Experience        

  • 5 years clinical experience
  • 3 years Utilization Management or Case Management Experience

License/Registration/Certifications       

  • Valid Driver’s license with good driving record

 

Core Job Responsibilities

  • Responsible for the delegated Utilization Review activities for SRHS Health Plan, and others as needed.
  • Coordinates outpatient service review, precertification review, and certification review activities.
  • Review all incoming clinical for outpatient service precertification using specified criteria.
  • Facilitate discussions with RHP Medical Director of cases that require clinical review related to active cases, extended length of stay, catastrophic cases, difficult discharge dispositions, and appropriate levels of care. Refer any cases to external specialist for review when needed.
  • Performs subsequent reviews based on criteria guidelines.
  • Communicates daily with outside facilities/providers results of requested review. Displays appropriate communicates avenues with facilities, case managers and DCP’s.
  • Maintains documents and service in a manner that achieves and maintains member confidentiality and is consistent with HIPAA guidelines.
  • Maintain and update data bases logging Medical Director Reviews, Appeal and statistics in compliance with URAC standards.
  • Research and review any claims issues related to utilization management and / or medical necessity from Third Party Administrator. Communicate results of review to Third Party Administrator.
  • Maintain and update data bases logging Medical Director Reviews, Appeal and statistics in compliance with URAC standards.
  • Professionally manages member/customer requests and complaints. Seeks to resolve customer complaints and problems. Provides information regarding the appeal process to members as requested, and serves as a resource to members, providers, and RHP.
  • Provide notification to Stop Loss carrier and Third-Party Administrator of any plan participant with potential high dollar claims based on medical reviews.
  • Provide clinical updates as requested
  • Work w/ Plan Administrators on unique cases that may require special considerations/exceptions to provide a sound quality and fiscal outcome.
  • Meets with appropriate physicians and other providers  to gain physician understanding and support for the CarePlus Medical Management Utilization Management Process.
  • Negotiates rate with any out-of-network services as needed.
  • Identify potential care management cases through readmissions, emergency room utilization, catastrophic diseases, high dollar treatments, and/or referrals from other CarePlus team members.
  • Determine any appropriate referrals to other CarePlus team members, not limited to, Transitional Care Program, Disease Management Program, Health Coach, or Community Programs.
  • All documents and data are timely, complete, and accurate.
  • Performs all duties within a timely manner.
  • All other duties as assigned.

What Spartanburg Regional Healthcare System employees say

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Benefits

Hours and flexibility

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About Spartanburg Regional Healthcare System

Sourced by ZipRecruiter

Spartanburg Regional Healthcare System is a leader in the healthcare industry, located in Spartanburg, SC, US. As a comprehensive health system, it offers services encompassing everything from wellness, prevention, and care coordination to specific medical treatments for a wide range of diseases and health issues. Spartanburg Regional Healthcare System was founded in 1921 and has since developed a reputation for excellence and innovative care, growing to include six hospitals, 100 medical offices, 8,000 associates and more than 900 medical staff.

Industry

Recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Spartanburg, SC, US

Year founded

1921

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