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Utilization Review Rn Jobs in Columbia, SC (NOW HIRING)

Lexington Medical Center

CDI Specialist RN

West Columbia, SC · On-site

$32.25 - $43.25/hr

Current RN License to Practice in the State of South Carolina; Currently has certification from ... Collaborates with physician, physician extender, nurse, case manager/utilization reviewer and ...

Lexington Medical Center

CDI Specialist RN

West Columbia, SC · On-site

$32.25 - $43.25/hr

Current RN License to Practice in the State of South Carolina; Currently has certification from ... Collaborates with physician, physician extender, nurse, case manager/utilization reviewer and ...

Angelic Helpers Llc

Registered Nurse RN

Columbia, SC · On-site

... Review aide's service checklist Conduct periodic visits to clients homes Qualifications Currently licensed Registered Nurse (RN) in state of employment Previous experience as a Registered Nurse is ...

Angelic Helpers Llc

Registered Nurse (RN)

Columbia, SC · On-site

$28 - $45/hr

Review aide's service checklist * Conduct periodic visits to clients homes Qualifications * Currently licensed Registered Nurse (RN) in state of employment * Previous experience as a Registered Nurse ...

Angelic Helpers Llc

Registered Nurse (RN)

Columbia, SC · On-site

$28 - $45/hr

Review aide's service checklist * Conduct periodic visits to clients homes Qualifications * Currently licensed Registered Nurse (RN) in state of employment * Previous experience as a Registered Nurse ...

Angelic Helpers Llc

Registered Nurse (RN)

Columbia, SC · On-site

$28 - $45/hr

Review aide's service checklist * Conduct periodic visits to clients homes Qualifications * Currently licensed Registered Nurse (RN) in state of employment * Previous experience as a Registered Nurse ...

CHAPPELL COMPANION CARE LLC

Registered Nurse

Columbia, SC · On-site

$30 - $40/hr

Registered Nurse (RN) - Home Care Agency (Part‐Time/Contract) Chappell Companion Care is seeking ... Review care plans and ensure compliance with SC regulations * Provide clinical oversight and ...

CHAPPELL COMPANION CARE LLC

Registered Nurse

Columbia, SC · On-site

$30 - $40/hr

Registered Nurse (RN) - Home Care Agency (Part‐Time/Contract) Chappell Companion Care is seeking ... Review care plans and ensure compliance with SC regulations * Provide clinical oversight and ...

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Showing results 21-40

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Columbia, SC

Utilization Review Rn information

See Columbia, SC salary details

$18

$36

$59

How much do utilization review rn jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for utilization review rn in Columbia, SC is $36.56, according to ZipRecruiter salary data. Most workers in this role earn between $28.89 and $41.97 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 Columbia, SC? The most popular types of Utilization Review Rn jobs in Columbia, SC are:
What are popular job titles related to Utilization Review Rn jobs in Columbia, SC? For Utilization Review Rn jobs in Columbia, SC, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Columbia, SC look for? The top searched job categories for Utilization Review Rn jobs in Columbia, SC are:
What cities near Columbia, SC are hiring for Utilization Review Rn jobs? Cities near Columbia, SC with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Columbia, SC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $76,037 per year, or $36.6 per hour.

Registered Nurse (RN)-Hospital Case Manager, Full-Time, Days

Prisma Health

Columbia, SC • On-site

Full-time

Re-posted 2 days ago

Prisma Health rating

7.1

Company rating: 7.1 out of 10

Based on 349 frontline employees who took The Breakroom Quiz

377th of 887 rated healthcare providers

Job description

Inspire health. Serve with compassion. Be the difference.
Job Summary
The Hospital Case Manager (HCM) provides case management service for hospital patients, including, but not limited to, utilization management to ensure efficient, cost-effective patient progression through the continuum of care and discharge to an appropriate level of care. 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.
  • Partners with the attending providers throughout hospitalization to promote effective and efficient utilization of clinical resources, ensuring quality, cost effective care. Anticipate next steps and facilitate communication to maximize care efficiencies for the patient and family.
  • Identifies social determinants of health that increase the patient's risk for negative outcomes. Ensures clear documentation for the interdisciplinary care team and coordinates post-acute plans with the ambulatory care management team as appropriate. Facilitates patient access to resources and relevant services.
  • Addresses and resolves system problems impeding diagnostic or treatment progress. Proactively identifies, resolves and documents delays and obstacles on the patient's behalf. Drives change by identifying areas where performance improvement is needed.
  • Navigates value-based care with expertise and ensures longitudinal plan is patient focused and aligns with patient and caregiver goals.
  • On the basis of preliminary risk screening, assesses patients' and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
  • 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 an acute care setting. Maintains care management knowledge to provide services in accordance with standards of practice as established by department and management.
  • Ensures medical necessity, appropriate level of care and timely implementation of plan of care in accordance with hospital(s) Utilization Review Plan.
  • Navigates the team through complex compliance, regulatory and insurance requirements. Coordinates with third party payors on a regular basis.
  • 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.
  • Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
  • Performs other duties as assigned.

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

Minimum Qualifications
  • Education - Bachelor's degree in Nursing
  • Experience - Three (3) years acute care nursing experience. One (1) year acute care case management experience preferred.

In Lieu Of
  • In lieu of the BSN requirement above, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within (4) four years of hire date. Further, employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment or may be terminated.
  • Employees in this title prior to 10/24/2021 are grandfathered into the title 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.
  • Accredited Case Manager (ACM) or Certified Case Manager (CCM) is preferred.

Knowledge, Skills and Abilities
  • Knowledge of Medical Necessity Criteria preferred.

Work Shift
Day (United States of America)
Location
Baptist
Facility
1520 Baptist Hospital
Department
15207517 Hospital Case 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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