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Remote Utilization Management Nurse Jobs in Ridgeville, SC

Tristar Insurance

Telephonic Medical Case Manager

SC · On-site +1

$85K - $92K/yr

Current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case ... Knowledge of utilization management, quality improvement, discharge planning, and or cost ...

Abbott

Implementation Project Manager

Charleston, 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

Charleston, 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 ...

Directive

PPC Manager (Remote US)

Charleston, SC · Remote

$70K - $95K/yr

Confirm lead routing is accurate within a CRM * Understand the value of Programmatic campaigns ... Responsible for personal productivity and utilization * Work directly with Associate Director to ...

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Remote Utilization Management Nurse information

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

As of Aug 28, 2026, the average hourly pay for remote utilization management nurse in Ridgeville, SC is $41.80, according to ZipRecruiter salary data. Most workers in this role earn between $33.03 and $47.98 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.

More about Remote Utilization Management Nurse jobs

What cities near Ridgeville, SC are hiring for Remote Utilization Management Nurse jobs?

Cities near Ridgeville, SC with the most Remote Utilization Management Nurse job openings:

Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Ridgeville, SC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $86,940 per year, or $41.8 per hour.

Market Physician Executive

Monogram Health

Charleston, SC • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 18 days ago

Job description

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) Float to lead its in-home multi-specialty polychronic care model across an assigned region. This role involves direct patient care, clinical oversight, and strategic leadership to improve patient well-being, quality of life, and health outcomes. The MPE Float will collaborate with a multidisciplinary team and community partners to deliver exceptional outcomes through evidence-based clinical pathways and disease treatment.

Practice Info

  • Lead an in-home multi-specialty polychronic care model in an assigned region to support all markets.
  • Each market is comprised of 5-10 practices led by local advanced practice providers (APP), registered nurses (RN), licensed clinical social workers (LCSW), and pharmacists (PharmD).
  • Collaborate with Monogram Health's Multi Specialty Platform to leverage employed specialists to deliver in-home specialty care.
  • Deploy a proven risk based model to ensure health equity and health equality leveraging proprietary next generation AI algorithms.
  • Focus on improving patient experience, population health outcomes, provider satisfaction, and lowering costs.
  • Oversee daily clinical and business operations through delivery of direct patient care, care management services, social worker support, and pharmacy services within the market.

Responsibilities

  • Know, understand, and deliver on Monogram Health's proprietary evidenced based clinical pathways.
  • Review and approve APP, RN, SW, and PharmD plans of care.
  • Overall accountability for reducing total cost of care and Medical Loss Ratio.
  • Provide direct and indirect patient care (including diagnosis and treatment of disease).
  • Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
  • Provide clinical guidance and direction to Market teams to drive Population Health Management activities.
  • Collaborate with Medical Economics, Finance, and other stakeholders to root cause and action against utilization trends.
  • Participate in Monogram On-Call activities.

Compensation

  • Competitive compensation
  • 401k with employer match

Benefits

  • Medical, dental, and vision insurance
  • Employee assistance program
  • Employer-paid and voluntary life insurance
  • Disability insurance
  • Health and flexible spending accounts
  • Financial wellness resources
  • Paid holidays
  • Flexible vacation time/PSSL
  • Paid parental leave
  • Work life assistance resources
  • Physical wellness perks
  • Mental health support
  • Employee referral program
  • BenefitHub for employee discounts

Shift & Schedule

  • 7 days on call minimum once/quarter

Requirements

  • Must be willing and able to obtain hospital privileges at required facilities.
  • This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.
  • Demonstrated experience applying evidence based clinical criteria.
  • Experience in renal care and geriatrics.
  • Strong management and communication skills.
  • Active, unrestricted state medical license required in each state within the market.
  • Experience with high need Medicare Advantage and managed Medicaid populations.
  • Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
  • Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
  • Willingness to become licensed in multiple states.
  • MD (Medical Doctor) or DO degree from an accredited medical school.
  • BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.

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