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Utilization Management Associate Jobs in South Carolina

Acadia Healthcare

Utilization Specialist

Lancaster, SC · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...

Acadia Healthcare

Utilization Specialist

Lancaster, SC · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...

Prisma Health

NP/ PA - Palmetto Medical Associates

Duncan, SC · On-site

$100K - $130K/yr

Establishment of quality assurance programs Establishment of utilization management programs ... Federal DEA license Work Shift Day (United States of America) Location Palmetto Medical Associates ...

Prisma Health

NP/ PA - Palmetto Medical Associates

Duncan, SC · On-site

$100K - $130K/yr

Establishment of quality assurance programs Establishment of utilization management programs ... Federal DEA license Work Shift Day (United States of America) Location Palmetto Medical Associates ...

Healthcare Support Staffing

RN Field Case Manager

Columbia, SC · On-site

$72K - $91K/yr

... Associates degree in Nursing. Bachelor's degree preferred. 1+ years of clinical nursing experience ... utilization management principles and healthcare managed care Experience with medical decision ...

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Utilization Management Associate information

What does a utilization management associate do?

A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.

What skills and qualifications are needed to thrive as a utilization management associate?

A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.

What are the typical daily responsibilities of a utilization management associate?

Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.

What is the difference between Utilization Management Associate vs Utilization Review Coordinator?

AspectUtilization Management AssociateUtilization Review Coordinator
CertificationsTypically requires a healthcare-related certification or licenseOften requires similar certifications, such as CCM or RHIA
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, insurance companies, or healthcare facilities
Job FocusAssists in reviewing medical necessity and authorization processesCoordinates and conducts utilization reviews and approvals
Common UsageUsed interchangeably in healthcare and insurance settingsOften used in hospital and insurance contexts

The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.

What are the most commonly searched types of Utilization Management jobs in South Carolina?

The most popular types of Utilization Management jobs in South Carolina are:

What cities in South Carolina are hiring for Utilization Management Associate jobs?

Cities in South Carolina with the most Utilization Management Associate job openings:

Infographic showing various Utilization Management Associate job openings in South Carolina as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Utilization Review Nurse

North Charleston, SC • On-site

Integrated Resources
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Integrated Resourcesexternal

Other

Re-posted 29 days ago

Job description

Utilization Review Nurse

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description

• Responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria to include reviewing pre-certification for outpatient and inpatient services

• Applying criteria to inpatient admissions and performing concurrent review functions, identifying discharge planning needs and referral of members to case management.

• Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines

• Utilizes clinical information to determine if criteria for medical necessity and benefit guidelines are met

Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision

• Documents all pertinent case information and dispositions for approvals and denials

• Refers all cases failing to meet interqual medical necessity criteria to Medical Director for review and final determination

• Communicates with providers to initiate/coordinate outpatient services/discharge planning needs for members

• Acts as a liaison to assure services are provided in the least restrictive, most cost effective and clinically appropriate setting

• Works with the Utilization Management Manager, the Medical Director and providers to ensure that complete medical information is available to allow utilization management decisions to be made within The Plan's standards for decision making

• Identifies potential members who may benefit from case management services and facilitates referral to the program

• Identifies and resolves any problems that could interfere with provider's continuity and coordination of care of members and refers unresolved problems to Manager

• Creates and maintains monthly reports on inpatient activities

• Performs other related duties and projects as assigned

• Adheres to ACFC policies and procedures

• Supports and carries out our Mission & Values.

Qualifications

• Associates RN degree required, Bachelor's degree preferred

• Two years of experience in managed care quality assurance or utilization review

• RN must have two years of experience in an acute care hospital.

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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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