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

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 ...

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 ...

Advocate Aurora Health

Financial Analyst Senior

Columbia, SC · On-site +1

$41.10 - $61.65/hr

Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI ... reviews, and reconciliation variances. * Research and document technical accounting issues serve as ...

CEI

RN/Case Management Coordinator - Remote

Columbia, SC · Remote

$30/hr

Remote- Onsite for Training (Must reside within 2 hours of Columbia, SC) Pay Rate: $30/hour ... Conduct utilization review and authorization activities to ensure services align with benefit plans ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Lexington, SC

Remote Utilization Review information

See Lexington, SC salary details

$18

$36

$59

How much do remote utilization review jobs pay per hour?

As of Jul 31, 2026, the average hourly pay for remote utilization review in Lexington, SC is $36.19, according to ZipRecruiter salary data. Most workers in this role earn between $28.61 and $41.59 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?

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 typical day look like for someone in a Remote Utilization Review role?

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 job?

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 Lexington, SC? The most popular types of Utilization Review jobs in Lexington, SC are:
What are popular job titles related to Remote Utilization Review jobs in Lexington, SC? For Remote Utilization Review jobs in Lexington, SC, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Lexington, SC look for? The top searched job categories for Remote Utilization Review jobs in Lexington, SC are:
What cities near Lexington, SC are hiring for Remote Utilization Review jobs? Cities near Lexington, SC with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Lexington, SC as of July 2026, with employment types broken down into 72% Full Time, 11% Part Time, and 17% Contract. Highlights an 42% Physical, 2% Hybrid, and 56% Remote job distribution, with an average salary of $75,278 per year, or $36.2 per hour.

Managed Care Coordinator

TRC Talent Solutions

Columbia, SC • Remote

$30/hr

Full-time

Posted 4 days ago

Job description

Managed Care Coordinator (RN / Licensed Clinician)
Pay: Up to $30/hr
Schedule: MondayFriday, 8:30 AM5:00 PM
Training: 1 week onsite
After Training: Remote (must live within 2 hours of Columbia, SC)
Equipment Provided
Position Summary
Responsible for reviewing and authorizing medical and/or behavioral health service requests to ensure services meet benefit coverage and medical necessity guidelines. Applies clinical expertise, contract knowledge, and utilization management principles to support quality, cost-effective member outcomes.
Ideal Candidate: A licensed clinician who is detail-oriented, tech-savvy, and comfortable working independently in a remote environment. Strong clinical judgment, time management, and communication skills are essential, along with the ability to prioritize workload and collaborate within a team-centered culture.
Key Responsibilities
  • Perform medical/behavioral utilization reviews and authorizations
  • Prioritize and review cases based on due dates and clinical documentation
  • Compare requests against policy and member contracts
  • Refer complex cases to Medical Director when needed
  • Communicate approvals/denials to providers
  • Ensure accurate documentation and regulatory compliance
Required Qualifications
  • Associate Degree in Nursing OR Masters in Social Work, Counseling, or Psychology
  • Active, unrestricted RN, LMSW, Counselor, or Psychologist license
  • Minimum 2 years of clinical experience
TRC Talent Solutions is proud to be an Equal Opportunity Employer (EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.