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Remote Utilization Review Rn Jobs in West Columbia, SC

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Quality Medical Auditor

Columbia, SC · Remote

... remote work. What You'll Do: * Determines methodology to identify cases for validation review ... Registered Records Administrator or Technician, OR, active, unrestricted RN licensure from the ...

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Remote Sales Rep- NO COLD CALLING

Columbia, SC · Remote

$50K - $120K/yr

... Firefighters, Nurses, and now, Veterans. For over 60 years, we have been the #1 provider of ... Review agreements regularly to develop cost-effective plans. What We're Looking For:

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Director, Trade Client Relations

Columbia, SC · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Varsity Tutors

NCLEX-PN Tutor

Columbia, SC · Remote

$18 - $40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in West Columbia, SC

Remote Utilization Review Rn information

See West Columbia, SC salary details

$19

$39

$63

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

As of Aug 9, 2026, the average hourly pay for remote utilization review rn in West Columbia, SC is $39.17, according to ZipRecruiter salary data. Most workers in this role earn between $30.96 and $45.00 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 job categories do people searching Remote Utilization Review Rn jobs in West Columbia, SC look for? The top searched job categories for Remote Utilization Review Rn jobs in West Columbia, SC are:
What cities near West Columbia, SC are hiring for Remote Utilization Review Rn jobs? Cities near West 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 West Columbia, SC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 17% Part Time, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $81,475 per year, or $39.2 per hour.

Clinical Documentation Integrity Specialist I, Full-Time, Days

Prisma Health

Columbia, SC • On-site, Remote

$32.25 - $43.25/hr

Full-time

Posted 12 days ago

Prisma Health rating

7.1

Company rating: 7.1 out of 10

Based on 349 frontline employees who took The Breakroom Quiz

378th of 887 rated healthcare providers

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Job Profile Summary
Reviews medical records to identify documentation opportunities to accurately represent the severity of illness, risk of mortality, length of stay, intensity of service, and hospital quality metrics. Reviews medical records, submits provider queries, and reconciles discharged records. Collaborates with Coding and other departments to facilitate the highest level of accuracy, quality, and completeness of provider documentation as well as accurate code assignment.

This position can be 100% remote

Essential Functions

  • All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health.Serve with compassion.Be the difference.

  • Conducts concurrent medical record reviews of selected patient health records to address clarity, completeness, consistency and accuracy of clinical documentation.

  • Employs the query process as needed to provide accurate documentation reflective of patient's severity of illness, risk of mortality, comorbid conditions, length of stay, principal diagnosis, and present on admission (POA) status.

  • Completes the reconciliation process to ensure accurate coding reflective of patient's severity of illness, risk of mortality, comorbid conditions, length of stay, principal diagnosis, and present on admission (POA) status.

  • Develops and maintains supportive, collaborative relationships with providers and health care team members to include education and follow up.

  • Stay current with coding guideline changes, changes in treatment modalities, clinical disease indicators, and compliant query policies.

  • Serves as a resource for co-workers, providers, and other support departments (coding, case management, quality, nutrition, etc.)

  • Assigns a working DRG for health care team discharge planning and CDI use.

  • Performs other duties as assigned

Supervisory/Management Responsibilities

  • This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

  • Education - Associate degree in Nursing, Health Information Management, or related field of study

  • Experience - Two (2) years -adult medical/surgical/critical care/ER/PACU nursing coding or related experience

In Lieu Of

  • In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: MD/DO/PA/NP

Required Certifications, Registrations, Licenses

  • RHIA/RHIT/CCS/CIC/or Licensure in related field of study/ Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Knowledge, Skills and Abilities

  • Computer skills

  • Communication skills with ability to interact with providers.

  • General knowledge of IPPS, ICD10 Coding, MS-DRG/APR-DRG and HCPCS coding systems preferred

Work Shift

Day (United States of America)

Location

Corporate - Columbia - Taylor at Marion

Facility

7001 Corporate

Department

70017540 Clinical Documentation Integrity

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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