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Remote Utilization Review Rn Jobs in Columbia, 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 ...

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. ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

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. ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

Absolute Total Care

Medical Director

Columbia, SC · On-site +1

$225K - $428K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Absolute Total Care

Medical Director

Columbia, SC · On-site +1

$225K - $428K/yr

Performs medical review activities pertaining to utilization review, quality assurance, and medical ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) This position requires a BSN RN with experience in maternity ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

Varsity Tutors

NCLEX-RN Tutor

Columbia, SC · Remote

$18 - $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 ...

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 ... Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by ...

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Remote Utilization Review Rn information

See Columbia, SC salary details

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$39

$63

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

As of Aug 5, 2026, the average hourly pay for remote utilization review rn 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 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 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 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 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 are popular job titles related to Remote Utilization Review Rn jobs in Columbia, SC? For Remote Utilization Review Rn jobs in Columbia, SC, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Columbia, SC look for? The top searched job categories for Remote Utilization Review Rn jobs in Columbia, SC are:
What cities near Columbia, SC are hiring for Remote Utilization Review Rn jobs? Cities near Columbia, SC 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 Columbia, SC as of July 2026, with employment types broken down into 84% Full Time, 12% Part Time, and 4% Contract. Highlights an 60% Physical, 3% Hybrid, and 37% Remote job distribution, with an average salary of $81,362 per year, or $39.1 per hour.

RN/Case Management Coordinator - Remote

CEI

Columbia, SC • Remote

$30/hr

Full-time

Posted 6 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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