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Remote Utilization Review Rn Jobs in Simpsonville, SC

Varsity Tutors

NCLEX Tutor

Greenville, SC · Remote

$25 - $40/hr

Adapts instruction using NCLEX review resources, practice question banks, and clinical scenario analysis to support nursing graduates preparing for first-time licensure as registered nurses or ...

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Remote Utilization Review Rn information

See Simpsonville, SC salary details

$18

$37

$61

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

As of Jul 16, 2026, the average hourly pay for remote utilization review rn in Simpsonville, SC is $37.47, according to ZipRecruiter salary data. Most workers in this role earn between $29.62 and $43.03 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

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 Simpsonville, SC? For Remote Utilization Review Rn jobs in Simpsonville, SC, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Simpsonville, SC look for? The top searched job categories for Remote Utilization Review Rn jobs in Simpsonville, SC are:
What cities near Simpsonville, SC are hiring for Remote Utilization Review Rn jobs? Cities near Simpsonville, 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 Simpsonville, SC as of July 2026, with employment types broken down into 86% Full Time, 11% Part Time, and 3% Contract. Highlights an 40% Physical, 3% Hybrid, and 57% Remote job distribution, with an average salary of $77,945 per year, or $37.5 per hour.
Coder Quality Auditor

Coder Quality Auditor

Ensemble Health Partners

Greer, SC • Remote

$57K - $99K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Ensemble Health Partners rating

6.5

Company rating: 6.5 out of 10

Based on 239 frontline employees who took The Breakroom Quiz

140th of 148 rated financial services

Job description

CAREER OPPORTUNITY OFFERING:

  • Bonus Incentives
  • Paid Certifications
  • Tuition Reimbursement
  • Comprehensive Benefits
  • Career Advancement
  • This position pays between $57,400 to $99,000 annually based on experience

The Coder Quality Auditor conducts monthly and quarterly quality assessments of individual codes. Provides guidance and education to coding associates and leaders on established coding guidelines and procedures. Performs additional quality assurance follow-up reviews to assess comprehension of education and training efforts. Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards and following CMS/AMA guidelines.  Candidate should possess the ability to code and a clear understanding of the coding principles and guidelines for multiple specialties. 

Job Responsibilities:

  • Quality Review - Monitors and audits inpatient and outpatient accounts across the system, looking at physician coding for both inpatient and outpatient accounts. Performs initial baselines as well as quarterly performance quality assurance reviews to assess coders’ comprehension and further assess ongoing education. Also assists in special project audits, as assigned. 
  • Educating - Assesses the educational needs of coding staff based on individual coder audit results and overall trends. Creates presentations, develops learning material, handbook and other educational materials. 
  • Edits/Denials/Coding - Assists operational coding team with initial coding, edits, and denials and appeals on an as needed basis.
  • Training - Assists with training new and existing staff. Develops all training materials and coding aids for both formal training and use by coders in daily work. Identifies coders to be cross-trained and suggests areas for training improvement. Assists in the implementation and administration of effective systems, processes, and procedures. 
  • Resource - Serves as a technical resource for all involved personnel; ensures that information is accurate and current, meeting AMA, CMS, and professional coding standards. Performs miscellaneous job-related duties as assigned.
  • Reporting - Provides reports of audit findings to coding management, individual coders and leadership as needed/requested along with providers that are contracted/employed and outlined in the client SOW.  Assists with the creation of various documents and reports as requested. Immediately provides reports related to compliance risks when requested. 

Experience We Love:

  • 5+ years of coding experience. 

  • 3+ years of auditing experience. 

  • Proficiency in multiple EMR’s, encoders, and the Microsoft Office suite. 

  • Educated in HIPAA regulations; must maintain strict confidentiality of patient and client information. 

  • Consistently achieves quality and productivity standards. 

  • Ability to organize and complete work in a timely manner. 

  • Ability to read, write and effectively communicate in English. 

  • Ability to understand medical/surgical terminology. 

  • Above average written and verbal communication skills. 

  • Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences. 

  • This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Minimum Education:

  • Associates degree or equivalent experience 

Required Certifications:

Candidates must have and keep current at least one of the following professional certifications (CPC, CPMA or CCS Preferred):

  • CPC (Certified Professional Coder)
  • CCS-P (Certified Coding Specialist-Phys Based)
  • CCS (Certified Coding Specialist)
  • CMPA (Certified Professional Medical Auditor)
  • RHIA (Registered Health Information Administrator)
  • RHIT (Registered Health Information Technician)

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