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Utilization Management Jobs in Lexington, SC (NOW HIRING)

UHS

Utilization Review Coordinator

West Columbia, SC

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

UHS

Utilization Review Coordinator

West Columbia, SC

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

Absolute Total Care

Medical Director

Columbia, 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 ...

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All JobsUtilization Management JobsUtilization Management Jobs in Lexington, SC

Utilization Management information

See Lexington, SC salary details

$33.4K

$76.6K

$139.5K

How much do utilization management jobs pay per year?

As of Jul 29, 2026, the average yearly pay for utilization management in Lexington, SC is $76,593.00, according to ZipRecruiter salary data. Most workers in this role earn between $55,200.00 and $89,400.00 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 Lexington, SC? For Utilization Management jobs in Lexington, SC, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Lexington, SC look for? The top searched job categories for Utilization Management jobs in Lexington, SC are:
What cities near Lexington, SC are hiring for Utilization Management jobs? Cities near Lexington, SC with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Lexington, SC as of July 2026, with employment types broken down into 72% Full Time, 14% Part Time, and 14% Contract. Highlights an 71% In-person, and 29% Remote job distribution, with an average salary of $76,593 per year, or $36.8 per hour.

Registered Nurse (RN) - Utilization Management, PRN, Days

Prisma Health

Columbia, SC • On-site

Part-time

Re-posted 12 days ago

Prisma Health rating

7.1

Company rating: 7.1 out of 10

Based on 347 frontline employees who took The Breakroom Quiz

375th of 890 rated healthcare providers

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Screens patients to obtain clinical information and make timely contacts with insurers to provide clinical information to support physician referrals. In collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care.
Essential Functions

  • All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.

  • Uses established clinical guidelines for initial/admission and continued stay reviews for patients within assigned unit to ensure medical necessity, appropriate level of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan and CMS regulation.

  • Maintains expert level knowledge of body systems and expected clinical outcomes for patient disease process. Maintains current knowledge of changes in state and federal regulatory requirements related to the provision of care management services in the acute care setting.

  • Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary. Includes, but not limited to, delivery of the regulatory documents as provided by CMS.

  • Consults with interdisciplinary team, Physician Advisor and administrative leadership as necessary to resolve barriers regarding progression of care. Collaborates with physicians throughout hospitalization, develops an effective working relationship, and provides expertise regarding payor and regulatory guidelines.

  • Promotes effective and efficient utilization of clinical resources, ensuring quality, cost effective care. Provides timely clinical reviews to third party payors. Responds to requests for additional information within 24 hours or next business day.

  • Partners with RN Hospital Care Managers and SW Hospital Care Managers to resolve payer related barriers. Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.

  • Performs other duties as assigned.

Supervisory/Management Responsibility

  • This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

  • Education - Bachelor's degree in Nursing

  • Experience - Two (2) years acute care nursing experience. One (1) year acute case management or utilization management experience preferred. Utilization management experience is preferred.

In Lieu Of

  • Employees in this title prior to 6/1/2025 are grandfathered into the job profile and are only required to have an AD N or Nursing Diploma.

Required Certifications, Registrations, Licenses

  • Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.

Knowledge, Skills and Abilities

  • Medical Necessity Criteria (Interqual, MCG) knowledge preferred.

Work Shift

Day (United States of America)

Location

Corporate - Columbia - Taylor at Marion

Facility

7001 Corporate

Department

70017535 Utilization Management

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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