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Utilization Management Associate Jobs in Spartanburg, SC

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 ...

Prismahealth

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 ...

AFL

Fiber Planning and Utilization Analyst

Duncan, SC · On-site

... associates worldwide. At AFL, we recognize that our employees are our greatest asset. We hire and ... management processes, controls, and accuracy metrics 3+ years of manufacturing experience with ...

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All JobsUtilization Management Associate JobsUtilization Management Associate Jobs in Spartanburg, SC

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.

Infographic showing various Utilization Management Associate job openings in Spartanburg, SC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 17% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

NP/ PA - Palmetto Medical Associates

Duncan, SC • On-site

Prisma Health
Health Care and Social Assistance • 10K+ employees
Learn more about Prisma Healthexternal

$100K - $130K/yr

Full-time

Re-posted 10 days ago

Prisma Health rating

7.1

Company rating: 7.1 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

Job description

Inspire health. Serve with compassion. Be the difference.
Job Summary
Provides primary health care to a specific patient population within the guidelines of written protocols. Follows established nursing standards, procedures, and practices.
Accountabilities
  • Engages in the diagnosis and treatment of disease, defects or injuries and recommend or prescribe treatments for the relief or cure of physical, mental or functional ailments or defects.
  • Performs all charting, summaries, correspondence and assorted paperwork that is required for purposes of documenting care and billing.
  • Participates in physician educational programs provided by Employer relative to capitated medicine and its implications on physician practice patterns.
  • Participates in responding to requests for proposals for managed care contracts.
  • Participates in:
    Establishment of quality assurance programs
    Establishment of utilization management programs
    Selection of management information systems
    Development of patient education services
    Development of patient satisfaction surveys
  • Assists in the development of operational and capital budgets.
  • Participates in operational assessments in search of revenue enhancement, expense reductions, consolidation efficiencies and billing opportunities.
  • General Job Expectations:
    Maintain courteous and cooperative working relationships with all levels of management and employees, physicians, patients, guarantors and the general public.
  • Participates in activities that would further the public's image of the Employer.

Supervisory/Management Responsibility
This is a non-management job that will report to a supervisor, manager, director, or executive.
Minimum Requirements
Master's Degree in Nursing; Nurse Practitioner Degree Emphasis or Program Certificate equivalent.
Required Certifications/Registrations/Licenses
  • South Carolina Official Recognition Nurse Practitioner - NLNP
  • Prescriptive Authority South Carolina Nursing License
  • South Carolina Controlled Substance license; Federal DEA license

Work Shift
Day (United States of America)
Location
Palmetto Medical Associates
Facility
2020 Palmetto Medical Associates
Department
20201000 Palmetto Medical Associates-Practice Operations
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