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Utilization Management Jobs in Anderson, SC (NOW HIRING)

Prismahealth

PRN Nurse Practitioner - Wound Care

Easley, SC · On-site

$104K - $143K/yr

Establishment of quality assurance programs Establishment of Utilization Management programs Selection of management information systems Development of patient education surveys Development of ...

Prisma Health

PRN Nurse Practitioner - Wound Care

Easley, SC · On-site

$104K - $143K/yr

Establishment of quality assurance programs Establishment of Utilization Management programs Selection of management information systems Development of patient education surveys Development of ...

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Utilization Management information

See Anderson, SC salary details

$35.7K

$81.9K

$149.2K

How much do utilization management jobs pay per year?

As of Jul 16, 2026, the average yearly pay for utilization management in Anderson, SC is $81,911.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,000.00 and $95,700.00 per year, depending on experience, location, and employer.

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

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are popular job titles related to Utilization Management jobs in Anderson, SC? For Utilization Management jobs in Anderson, SC, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Anderson, SC look for? The top searched job categories for Utilization Management jobs in Anderson, SC are:
What cities near Anderson, SC are hiring for Utilization Management jobs? Cities near Anderson, SC with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Anderson, SC as of July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $81,911 per year, or $39.4 per hour.
Utilization Management Specialist II

Utilization Management Specialist II

AnMed

Anderson, SC • On-site

Full-time

Medical, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

AnMed rating

7.2

Company rating: 7.2 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

329th of 886 rated healthcare providers

Job description

Located in the heart of Anderson, South Carolina, AnMed is a dynamic, not-for-profit health system dedicated to delivering exceptional care with compassion, innovation, and integrity. At AnMed, our mission is simple yet powerful:

To provide exceptional and compassionate care to all we serve.
 

AnMed has been named one of the Best Employers in South Carolina by Forbes, reflecting our commitment to a supportive, inclusive, and purpose-driven workplace. Whether you're just starting your career or looking to grow in a new direction, you'll find opportunities to thrive, lead, and make a meaningful impact here.

This position is responsible for performing the daily operations of the Utilization Management program at AnMed within the Care Coordination model. These duties include but are not limited to initial medical necessity review, continued stay/concurrent review, retrospective review, bed status management, resource utilization management, regulatory compliance, and related denial management issues.

Duties & Responsibilities

  • Performs assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all required patient types within defined review standards, including daily review for discharges and transfers.
  • Uses clinical knowledge to independently review the medical record for clinical appropriateness and resource utilization including but not limited to : patient acuity and related clinical services, applies approved medical necessity criteria for screening of level of care as needed/required, documentation appropriateness/accuracy, and makes recommendation as to appropriateness of clinical level of care e.g. inpatient vs outpatient, documentation accuracy of severity of illness and intensity of services, regulatory compliance with documentation and physician orders.
  • Reviews all available clinical information per individual case to determine medical necessity, appropriateness of services, and targeted length of stay based on approved criteria and standards.
  • Communicates /oversees communication of clinical information to required third parties in a timely and knowledge manner within defined review and/or contractual standards.
  • Initiates peer-to-peer i.e. MD to MD calls with payer physician to avoid denials.

Qualifications

  • Minimum of two years of clinical experience required with current SC license as RN.
  • Bachelor of Science in nursing.
  • Excellent communication skills, written and verbal.
  • Excellent communication skills and computer experience
  • Ability to work independently and meet deadlines and schedules

Preferred Qualifications

  • Utilization management experience.

Benefits*

  • Medical Insurance & Wellness Offerings.
  • Compensation, Retirement & Financial Planning.
  • Free Financial Counseling.
  • Work-Life Balance & Paid Time Off (PTO).
  • Professional Development.
  • For more information, please visit: anmed.org/careers/benefits

*Varied benefits packages are available for positions with a 0.6 FTE or higher.

What AnMed employees say

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About AnMed

Sourced by ZipRecruiter

AnMed is a dynamic, comprehensive health system in Anderson, S.C. For more than 100 years, AnMed has provided health care for residents of eight counties in upstate South Carolina and northeast Georgia. AnMed’s medical staff includes more than 400 physicians, and over 3,600 employees. AnMed has been an inseparable part of the Anderson community for more than a century. From its modest beginning as a 25-bed hospital in 1908, AnMed has evolved into the state’s largest independent, not-for-profit health system with more than 50 patient care sites and nearly 4,000 employees. Our goal is to provide excellent care. The health system is anchored by the 461-bed Medical Center in Anderson. AnMed also has a satellite North Campus which includes a comprehensive Cancer Center, physician offices, AnMed Rehabilitation Hospital and the Cardiac and Orthopaedic Center. AnMed Cannon, located in Pickens, South Carolina, is also part of the system.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Anderson, SC, US

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