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Utilization Management Jobs in Moncks Corner, SC

Global Force

Care Connector

North Charleston, SC · On-site

North Charleston- SC 29405 Contract role for 3 months with possibility of extension The Care Connector is responsible for supporting the daily operations of integrated care management and utilization ...

Tristar Insurance

Telephonic Medical Case Manager

SC · On-site +1

$85K - $92K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Knowledge of utilization management, quality improvement, discharge planning, and or cost management. * Ability to solve practical problems and deal with a variety of variables. * Possess planning ...

Monogram Health

Market Physician Executive

Charleston, SC · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience with high need Medicare Advantage and managed Medicaid populations. * Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk ...

Zunch Staffing

Director Case Management

Charleston, SC · On-site

$102K - $153K/yr

... utilization. The Director is responsible for daily operations, achieving outcomes, and engaging ... Oversee core case management functions and practices. * Ensure adherence to care coordination and ...

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All JobsUtilization Management JobsUtilization Management Jobs in Moncks Corner, SC

Utilization Management information

See Moncks Corner, SC salary details

$34.2K

$78.6K

$143.1K

How much do utilization management jobs pay per year?

As of Aug 13, 2026, the average yearly pay for utilization management in Moncks Corner, SC is $78,570.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,600.00 and $91,800.00 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 popular job titles related to Utilization Management jobs in Moncks Corner, SC? For Utilization Management jobs in Moncks Corner, SC, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Moncks Corner, SC look for? The top searched job categories for Utilization Management jobs in Moncks Corner, SC are:
What cities near Moncks Corner, SC are hiring for Utilization Management jobs? Cities near Moncks Corner, SC with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Moncks Corner, SC as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $78,570 per year, or $37.8 per hour.

Utilization Review Nurse

Careers Integrated Resources Inc

North Charleston, SC • On-site

Other

Posted 3 days ago

New

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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