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Utilization Review Rn Jobs in South Carolina (NOW HIRING)

UHS

Utilization Review Coordinator

West Columbia, SC

Masters' degree in a recognized mental health field or Registered Nurse. * Experience: * Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent ...

UHS

Utilization Review Coordinator

West Columbia, SC

Masters' degree in a recognized mental health field or Registered Nurse. * Experience: * Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Masters' degree in a recognized mental health field or Registered Nurse. * Experience: * Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent ...

UHS

Utilization Review Coordinator

West Columbia, SC

Masters' degree in a recognized mental health field or Registered Nurse. * Experience: * Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent ...

UHS

Utilization Review Coordinator

West Columbia, SC

Masters' degree in a recognized mental health field or Registered Nurse. * Experience: * Minimum of two years psychiatric experience in chart analysis and in the utilization review field. Excellent ...

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Utilization Review Rn information

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$39

$64

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in South Carolina is $39.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.01 and $45.05 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in South Carolina? The most popular types of Utilization Review Rn jobs in South Carolina are:
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What cities in South Carolina are hiring for Utilization Review Rn jobs? Cities in South Carolina with the most Utilization Review Rn job openings:
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in South Carolina as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $81,610 per year, or $39.2 per hour.

Utilization Review Nurse

Integrated Resources INC

North Charleston, SC

Full-time

Re-posted 11 days ago

Job description

Company Description

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.

Additional Information

Thanks

Warm Regards

Ricky Bansal

732-429-1925

Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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