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Remote Utilization Review Jobs in Moncks Corner, SC

Tristar Insurance

Supervisor, Case Management

SC · On-site +1

$110K - $118K/yr

This position involves close collaboration with the Nurse Triage, Utilization Review, Case Management and Pharmacy teams. The Supervisor must have up-to-date knowledge of evidence-based nursing ...

Amerihealth Caritas

Care Manager II

Charleston, SC · Remote

This is a remote position with a requirement of a South Carolina resident and a BSN RN license ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

Amerihealth Caritas

Care Manager II

Charleston, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

Amerihealth Caritas

Care Manager II

Charleston, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Review medication list and educate Members with pharmacy needs, and counsel on side effects and ...

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Remote Utilization Review information

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$18

$37

$60

How much do remote utilization review jobs pay per hour?

As of Jul 30, 2026, the average hourly pay for remote utilization review in Moncks Corner, SC is $37.13, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $42.64 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 popular job titles related to Remote Utilization Review jobs in Moncks Corner, SC? For Remote Utilization Review jobs in Moncks Corner, SC, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Moncks Corner, SC look for? The top searched job categories for Remote Utilization Review jobs in Moncks Corner, SC are:
What cities near Moncks Corner, SC are hiring for Remote Utilization Review jobs? Cities near Moncks Corner, SC with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Moncks Corner, SC as of July 2026, with employment types broken down into 71% Full Time, 13% Part Time, and 16% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $77,222 per year, or $37.1 per hour.

(RN) Remote Care Review Clinician - Utilization Review

Molina Healthcare

Charleston, SC • Remote

$25.08 - $51.49/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 197 frontline employees who took The Breakroom Quiz

160th of 299 rated insurance

Job description

JOB DESCRIPTION 

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
• Processes requests within required timelines. 
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
• Requests additional information from members or providers as needed. 
• Makes appropriate referrals to other clinical programs. 
• Collaborates with multidisciplinary teams to promote the Molina care model. 
• Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single state or Compact RN License. 
• Ability to prioritize and manage multiple deadlines. 
• Excellent organizational, problem-solving and critical-thinking skills. 
• Strong written and verbal communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
• Certified Professional in Healthcare Management (CPHM). 
• Recent hospital experience in an intensive care unit (ICU) or emergency room. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $25.08 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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