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Remote Utilization Review Rn Jobs in South Carolina

Varsity Tutors

NCLEX-RN Tutor

Charleston, SC · Remote

$40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

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Remote Utilization Review Rn information

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$19

$39

$64

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

As of Sep 12, 2026, the average hourly pay for remote utilization review rn in South Carolina is $39.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.01 and $45.05 per hour, depending on experience, location, and employer.

What is a remote utilization review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

What are the key skills and qualifications needed to thrive as a remote utilization review RN?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are popular job titles related to Remote Utilization Review Rn jobs in South Carolina?

For Remote Utilization Review Rn jobs in South Carolina, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in South Carolina look for?

The top searched job categories for Remote Utilization Review Rn jobs in South Carolina are:

What cities in South Carolina are hiring for Remote Utilization Review Rn jobs?

Cities in South Carolina with the most Remote Utilization Review Rn job openings:

Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in South Carolina as of September 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 100% Remote job distribution, with an average salary of $81,610 per year, or $39.2 per hour.

Medical Management Coordinator (Remote)

Spartanburg, SC • Remote

Spartanburg Regional Healthcare System
Recruiting and Staffing Services • 5 - 10K employees
Learn more about Spartanburg Regional Healthcare Systemexternal

Full-time

Posted 18 days ago

Spartanburg Regional Healthcare System rating

6.7

Company rating: 6.7 out of 10

Based on 118 frontline employees who took The Breakroom Quiz

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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