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Remote Utilization Review Jobs in Columbia, SC (NOW HIRING)

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 ...

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 ...

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

New

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 ...

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 ...

Remote Utilization Review information

See Columbia, SC salary details

$19

$39

$63

How much do remote utilization review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for remote utilization review 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 in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What are the most commonly searched types of Utilization Review jobs in Columbia, SC? The most popular types of Utilization Review jobs in Columbia, SC are:
What job categories do people searching Remote Utilization Review jobs in Columbia, SC look for? The top searched job categories for Remote Utilization Review jobs in Columbia, SC are:
What cities near Columbia, SC are hiring for Remote Utilization Review jobs? Cities near Columbia, SC with the most Remote Utilization Review job openings:
Infographic showing various Remote Utilization Review job openings in Columbia, SC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $81,362 per year, or $39.1 per hour.

Supervisory Acquisition and Utilization Specialist

Veterans Health Administration

Columbia, SC • On-site, Remote

$89K - $116K/yr

Full-time

PTO

Posted 7 days ago


Veterans Health Administration rating

8.1

Company rating: 8.1 out of 10

Based on 1,004 frontline employees who took The Breakroom Quiz

69th of 887 rated healthcare providers


Job description

Summary
The Supervisory Acquisition Utilization Specialist renders expert contract pre-award & post award expertise to all Administrative/Clinical Service lines within the VA Healthcare System (HCS) and supported catchment area. Serves as a liaison/advisor on contract related services focusing on critical clinical and healthcare services, facility and environmental services, product acquisition and support services; supervises a minimum of 3Acquisition Utilization Specialists and 4 Purchasing Agents.
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Duties
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Duties include, but may not be limited to the following:
  • Directs, maintains, and carries out management duties involving many separate and distinct phases of operations within the Business and Procurement Planning and Purchasing sector in the Supply Chain Service.
  • Supervises employees from separate but interrelated units and conducts semi-annual and annual performance reviews.
  • Assists subordinate staff with performance issues as necessary; schedules and grants leave; and monitors overtime usage.
  • Resolves informal complaints and grievances, discusses corrective actions with employees, and recommends appropriate disciplinary and/or adverse action.
  • Plans, coordinates, and evaluates the logistical actions required to support the clinical and administrative mission that the organization provides.
  • Establishes, expedites, and reviews the micro-purchase orders and consolidation of all procurement packages.
  • Serves as the Approving Official for approving reconciled purchase card transactions; and exercises Ordering Officer Authority in determining best value and contract sourcing.
  • Develops sole source justifications in relation to cost, limited availability or unusual nature.
  • Negotiates performance requirements among multiple sites and service lines to obtain agreement and standardize enterprise equipment, supply, and/or service requirements.
  • Prepares and processes requisitions and procurement packages to the Network Contracting Activity (NCA) for award for facility wide fund control activities; and interfaces with Fiscal/budget staff to resolve obligation and reconciliation issues.
  • Furnishes instructions and explanations on new regulations and procedures; and prepares reports, briefs, and contract data for meetings, inspections, audits and in-progress reviews.
  • Coordinates with leadership, staff, and other stakeholders to develop and execute acquisition strategies; and conducts analyses and recommends courses of actions.
  • Monitors the procurement process from pre-award to final delivery of requirements; and ensures compliance with the terms of contracts.
  • Advises on all phases of negotiation with the contract specialist/contracting officer for contract modifications, change orders, supplemental agreements, delivery order processes and all phases of contract administration.
  • Performs other duties as assigned.

Work Schedule: Monday - Friday, 8:00am - 4:30pm
Telework: This position may be authorized for telework. Telework eligibility will be discussed during the interview process.
Virtual: This is not a virtual position.
Position Description/PD#: Supervisory Acquisition and Utilization Specialist/99867-S
Relocation/Recruitment Incentives: Not authorized
Critical Skills Incentive (CSI): Not approved
Permanent Change of Station (PCS): Not authorized
Requirements
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Conditions of employment
  • You must be a U.S. Citizen to apply for this job
  • To be considered for this position, you must complete all required steps in the process. In addition to the application and questionnaire, this position requires an online assessment. The online assessment measures critical general competencies required to perform the job.
  • Physical Requirements: The work required does not inherently include any physical requirements essential for successful job performance that could not otherwise be performed with accommodation or workplace adjustment. A pre-placement physical examination is not required.
  • Subject to background/security investigation
  • Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued identification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
  • Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP)

As a condition of employment for accepting this position, you will be required to serve a 1-year probationary period or 2-year trial period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:
  • your performance and conduct;
  • the needs and interests of the agency;
  • whether your continued employment would advance organizational goals of the agency or the Government; and
  • whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.
Qualifications
To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 08/10/2026.
Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-12 position you must have served 52 weeks at the GS-11. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment.
You may qualify based on your experience as described below:
  • Specialized Experience: One (1) full year of specialized experience equivalent to the GS-11 level in the Federal Service that has equipped you with the particular knowledge, skills and abilities to successfully perform the duties of a Supervisory Acquisition Utilization Specialist, and that is typically in or related to the work of this position. Specialized experience includes: serving as a team lead or senior specialist assisting with the direction and control of supply chain planning; handling contract related services, product acquisition, and procurement of items in a healthcare environment; overseeing contracts from pre-award to post-award; preparing procurement packages including development of requirement documents (e.g. performance work statements and objectives, cost benefit analysis, sole source justifications, etc.); developing and analyzing reports to make recommendations on acquisition and contracting issues; participating in negotiations throughout all phases of contract administration; and monitoring expenditures and reporting on deviations from contract terms. This position requires some degree of specialized knowledge and experience of logistics support activities in areas of acquisition management, contracting, purchasing, transportation, distribution, inventory management and control, expendable and non-expendable equipment, and warehouse operations.

Preferred Experience: Certification in Federal Acquisition (such as FAC-C, FAC-COR, or DAWIA certification) is highly desirable. Experience preparing contract actions and government purchase card requests. Demonstrated ability to communicate both orally and in writing, presenting information to management, staff, and external partners.
For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.
Physical Requirements: Work is primarily sedentary in nature. Requires occasional travel to conduct inspections of contract facilities or motor vehicles providing contracts for healthcare resources to ensure Joint Commission and safety requirements are met.
Education
There is no educational substitution at this grade level.
Additional information
Under the Fair Chance to Compete Act, the Department of Veterans Affairs prohibits requesting an applicant's criminal history prior to accepting a tentative job offer. For more information about the Act and the complaint process, visit Human Resources and Administration/Operations, Security, and Preparedness (HRA/OSP) at The Fair Chance Act.
Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.
Receiving Service Credit for Earning Annual (Vacation) Leave: Federal Employees earn annual leave at a rate (4, 6 or 8 hours per pay period) which is based on the number of years they have served as a Federal employee. VA may offer newly-appointed Federal employee's credit for their job-related non-federal experience or active duty uniformed military service. This credited service can be used in determining the rate at which they earn annual leave. Such credit must be requested and approved prior to the appointment date and is not guaranteed.
This job opportunity announcement may be used to fill additional vacancies.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced VA competitive service employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit appropriate documentation (a copy of the agency notice, your most recent performance rating, and your most recent SF-50 noting current position, grade level, and duty location) and be found well-qualified for this vacancy. To be well-qualified: applicants must possess experience that exceeds the minimum qualifications of the position including all selective factors, and who are proficient in most of the required competencies of the job. Information about ICTAP and CTAP eligibility is on OPM's Career Transition Resources website at http://www.opm.gov/policy-data-oversight/workforce-restructuring/employee-guide-to-career-transition/.
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Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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About Veterans Health Administration

Sourced by ZipRecruiter

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving millions of Veterans each year. Located in Phoenix, AZ, and many other parts of the US, the VHA operates under the Department of Veteran Affairs, as suggested by their official website va.gov. The VHA is dedicated to providing the highest level of comprehensive care to its veterans. The organization offers a broad spectrum of medical, surgical, and rehabilitative care, including mental health services, research, and pharmacy benefits.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Phoenix, AZ, US