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

ASK Consulting

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Case Management Coordinator/Registered (cur_1_128790@curatelyai.net)

Columbia, SC · Remote

$25 - $30/hr

Columbia, SC 29229-Remote Duration: 3 months contract Pay Range is $25-30. on W2 Shift: Monday ... Utilization Review & Authorization: Conduct medical/behavioral reviews and authorize services based ...

New

Bcbsa

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

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 ...

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 Aug 12, 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 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 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 August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 23% In-person, and 77% Remote job distribution, with an average salary of $75,278 per year, or $36.2 per hour.

Case Management Coordinator/Registered (cur_1_128790@curatelyai.net)

ASK Consulting

Columbia, SC • Remote

$25 - $30/hr

Contractor

Posted yesterday

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Job description

"All candidates must be directly contracted by ASK Consulting on their payroll and cannot be subcontracted. We are unable to provide sponsorship at this moment".


Job Title: Case Management Coordinator/Registered Nurse

Location: Columbia, SC 29229-Remote

Duration: 3 months contract

Pay Range is $25-30. on W2 

Shift: Monday through Friday, 8:30 am -5:00 pm. Two late shifts until 8:00 pm per month, 11:30 am - 8:00 pm, no late shifts on Fridays


Job Description:

Looking for a Customer Service

  • Clinical Case Management: Assess, plan, coordinate, monitor, and evaluate member care, medical necessity, benefits, eligibility, and service needs.
  • Utilization Review & Authorization: Conduct medical/behavioral reviews and authorize services based on clinical criteria, benefit guidelines, contracts, and medical necessity.
  • Clinical Experience: Requires 4 years of recent clinical experience in specialties such as oncology, cardiology, maternity, rehabilitation, mental health, orthopedics, or general medicine/surgery, OR 4 years of utilization review/case management/clinical experience with at least 2 years clinical.
  • Required Education & Licensure: Associate Degree in Nursing or accredited nursing program graduate, or applicable Master's degree in Social Work, Psychology, or Counseling, along with an active unrestricted RN, social worker, counselor, or psychologist license as applicable.
  • Member Education & Health Management: Provide telephonic support, chronic condition management, patient education, coaching, motivational interviewing, and interventions to improve member engagement and health outcomes.
  • Claims, Benefits & Healthcare Knowledge: Apply knowledge of claims, coding, contract language, benefit plans, provider networks, medical necessity, and healthcare delivery systems to support appropriate service decisions and claims adjudication.
  • Regulatory & Documentation Compliance: Maintain accurate clinical documentation and comply with applicable regulations and standards, including ERISA, NCQA, URAC, DOI, and DOL requirements.


About ASK: ASK Consulting is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Consulting connects people with amazing opportunities

ASK Consulting is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all associates.