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Utilization Management Jobs in Greer, SC (NOW HIRING)

Absolute Total Care

Medical Director

Greenville, SC · On-site +1

$225K - $428K/yr

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

Absolute Total Care

Medical Director

Greenville, SC · On-site +1

$225K - $428K/yr

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

Absolute Total Care

Medical Director

Simpsonville, SC · On-site +1

$225K - $428K/yr

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

Absolute Total Care

Medical Director

Simpsonville, SC · On-site +1

$225K - $428K/yr

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. * Performs medical review activities pertaining to utilization review ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Simpsonville, SC · On-site

$51.25 - $62.25/hr

Prior managed care or utilization management experience preferred -- retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills: Excellent ...

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Utilization Management information

See Greer, SC salary details

$37.5K

$86K

$156.7K

How much do utilization management jobs pay per year?

As of Aug 8, 2026, the average yearly pay for utilization management in Greer, SC is $86,037.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,000.00 and $100,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in utilization management, 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 utilization management?

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 the most commonly searched types of Utilization Management jobs in Greer, SC? The most popular types of Utilization Management jobs in Greer, SC are:
What are popular job titles related to Utilization Management jobs in Greer, SC? For Utilization Management jobs in Greer, SC, the most frequently searched job titles are:
What cities near Greer, SC are hiring for Utilization Management jobs? Cities near Greer, SC with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Greer, SC as of August 2026, with employment types broken down into 81% Full Time, 14% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $86,037 per year, or $41.4 per hour.

Case Manager

Spartanburg Regional Medical Center

Spartanburg, SC • On-site

$19.50 - $25.25/hr

Full-time

Re-posted 29 days ago

Spartanburg Regional Healthcare System rating

6.7

Company rating: 6.7 out of 10

Based on 117 frontline employees who took The Breakroom Quiz

533rd of 887 rated healthcare providers

Job description

Job Requirements
Position Summary
Under the supervision of the Manager, the Case Manager (CM) has knowledge and skill in the areas of discharge planning, transitions of care, utilization management (UM), medical necessity, and patient status determination. The CM facilitates effective processes based on the regulatory and reimbursement requirements of various commercial and governmental payers. The CM assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs. They provide cost-effective services while maintaining quality care through collaboration with health care providers to coordinate the transition of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. The CM performing utilization management (UM) provides the critical function of obtaining certification and approval of the patient's hospital stay as required by the payer.
Minimum Requirements
Education
  • Graduate of an accredited school of nursing, Bachelor's Degree (other than nursing) with an ADN or an accredited school of Social Work (MSW)

Experience
  • 1-3 years healthcare experience or 1-3 years Case Management experience (Care Coordination, Transitions of Care or Utilization Management)

License/Registration/Certifications
  • Current R.N. licensure in the state of SC or Current Social Work licensure in the state of SC

Preferred Requirements
Preferred Education
  • BSN, MSW

Preferred Experience
  • 3-5 years

Preferred License/Registration/Certifications
  • RN, LMSW

Core Job Responsibilities
  • Complies with established policies and procedures
  • Complies with regulatory requirements of utilization review and discharge planning
  • Responsible for assessment and reassessment of patients' physical, social, emotional and financial needs.
  • Develops a comprehensive patient centered discharge plan, incorporating the patient goal into the discharge plan
  • Communicates with the patient/family/care giver and interdisciplinary patient care team to facilitate patient care, development of a comprehensive patient centered discharge plan and utilization review functions
  • Negotiates timely decisions to expedite the discharge plan and ensure seamless transitions across the continuum of care
  • Documents clearly and concisely all contacts and information of the patient's case management
  • process in the medical record
  • Responsible for the core functions of the Utilization Management Plan
  • Performs initial and subsequent utilization reviews utilizing criteria.
  • With utilization review, obtains certification on admissions and continued certification by providing clinical information to the payer or to review companies designated by the patient's payer. Monitor and secures final certification up to and after patient discharge until resolved. Assists with management of incoming faxed communications
  • With utilization review, assists with initial denial, peer to peer information, status determination and/or appeal process and communicates necessary information to the physician advisor, CM manager, denials team manager and/or QIO as required
  • Uses communication tools to ensure that information is collected, reviewed, escalated if needed and disseminated appropriately for all commercial, managed care and government plans.
  • Communicates updated insurance information to the centralized referral center if insurance information provided is not accurate
  • Performs timely data entry of information when results are received including covered, denied and avoidable days.
  • Complies with delivery of regulatory notices - Important Message, Medicare Outpatient Observation Notice, Detailed Notice of Discharge and Hospital Issued Notices of Non-Coverage.
  • Plans effectively in order to meet patient needs, manage length of stay and promote efficient utilization of resources.
  • Provides cost-effective services through resource management and facilitating throughput while maintaining quality care and meeting customer service needs by collaborating with healthcare providers to coordinate care delivery
  • Provides patient/family/caregiver with quality data-based information on post-acute providers to facilitate referrals to meet the care transition needs of the patient
  • Utilizes a secure electronic platform to communicate with post-acute providers and payers
  • Completes required education and ongoing competencies as assigned
  • Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
  • Other duties as assigned

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About Spartanburg Regional Healthcare System

Sourced by ZipRecruiter

Spartanburg Regional Healthcare System is a leader in the healthcare industry, located in Spartanburg, SC, US. As a comprehensive health system, it offers services encompassing everything from wellness, prevention, and care coordination to specific medical treatments for a wide range of diseases and health issues. Spartanburg Regional Healthcare System was founded in 1921 and has since developed a reputation for excellence and innovative care, growing to include six hospitals, 100 medical offices, 8,000 associates and more than 900 medical staff.

Industry

Recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Spartanburg, SC, US

Year founded

1921

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