ZipRecruiter

Log In

2

Remote Utilization Review Jobs in Fort Mill, SC (NOW HIRING)

Addison Group

Intake Manager

Charlotte, NC · Remote

Charlotte, NC (Hybrid - onsite with one remote day per week) Compensation: $70,000 - $80,000 ... Lead, mentor, and develop a team of intake and utilization management specialists * Oversee the ...

Everblue

Program Manager, Home Energy Rebates Everblue · Remote (NC, MN, or NV) · Full-time About Everblue ... Track KPIs, budget utilization, and throughput. Produce the dashboards and narrative reports that ...

Everblue

Program Manager - MN, NC, or NV

NC · On-site +1

Program Manager, Home Energy Rebates Everblue • Remote (NC, MN, or NV) • Full-time About ... Track KPIs, budget utilization, and throughput. Produce the dashboards and narrative reports that ...

Tihinsurance

Senior Treasury Analyst

Charlotte, NC · Remote

English (Required) Work Shift: 1st Shift (United States of America) Please review the following ... This role is remote, but we would prefer someone in Charlotte, Dallas, Birmingham, New York ...

Atria Group LLC

Integration Eng - Remote

Charlotte, NC · Remote

$101K - $136K/yr

... by reviewing specifications and working with interface vendors and client technical teams to ... optimal utilization of extracts Work with cross-functional team and with end-users to achieve ...

JLL

Senior PDS Sourcing Manager

Charlotte, NC · Remote

$148K - $149K/yr

Participate and provide leadership to Preferred Supplier performance review meetings. * Support JLL ... Remote -Atlanta, GA, Charlotte, NC, Chicago, IL, Houston, TX If this resonates with you, we ...

next page

Showing results 1-20

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Fort Mill, SC

Remote Utilization Review information

See Fort Mill, SC salary details

$18

$37

$60

How much do remote utilization review jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for remote utilization review in Fort Mill, SC is $37.16, according to ZipRecruiter salary data. Most workers in this role earn between $29.38 and $42.69 per hour, depending on experience, location, and employer.

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 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 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 are the most commonly searched types of Utilization Review jobs in Fort Mill, SC?

The most popular types of Utilization Review jobs in Fort Mill, SC are:

What are popular job titles related to Remote Utilization Review jobs in Fort Mill, SC?

For Remote Utilization Review jobs in Fort Mill, SC, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Fort Mill, SC look for?

The top searched job categories for Remote Utilization Review jobs in Fort Mill, SC are:

What cities near Fort Mill, SC are hiring for Remote Utilization Review jobs?

Cities near Fort Mill, SC with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Fort Mill, SC as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $77,283 per year, or $37.2 per hour.

Medical Director-Physical Health (Full-time Remote, North Carolina Based)

Charlotte, NC • On-site, Remote

Alliance
See more jobs at Allianceexternal

$211K - $269K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 days ago

Job description

The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination.
This position will allow the successful candidate to work primarily remote. While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate. This position may be required to work weekends and holidays based on organizational and operational requirements.
Responsibilities & Duties
Clinical Oversight & Medical Review
  • Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care
  • Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services
  • Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards

Review Approval and Denial of Service and Level of Care Requests
  • Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department

Process Adherence, Quality & Efficiency
  • Follow department processes-as defined by approved Alliance policies, desk procedures, and workflows referenced on the Alliance Grid and in the Medical Director OneNote-to complete timely utilization reviews in Alliance's UM platform and perform tasks efficiently
  • Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance

Operational & Committee Support
  • Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee
  • Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams

External Engagement
  • Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support

Additional Responsibilities
  • Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services
  • Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes
  • Support cross functional teams with medical expertise, as needed
  • Provide consultation, training, and education to staff and community partners on relevant topics as needed
  • Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed

Maintain a Positive Environment
  • Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce
  • Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates
  • Ensure all staff are treated with respect and dignity
  • Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members

Minimum Requirements
Education & Experience
Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field. At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required.
Special Requirement
Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine).
Knowledge, Skills, & Abilities
  • Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
  • Knowledge of Managed Care Principles
  • Knowledge of recent developments in the field of medicine
  • Microsoft Office Skills
  • Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations
  • Utilization Management experience

Salary Range
$211,172 - $269,245/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

Apply