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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

$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

$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

Be Seen First

RN Registered Nurse

West Columbia, SC

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

Be Seen First

RN Registered Nurse

West Columbia, SC

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

Be Seen First

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

Be Seen First

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 ...

NHC

Registered Nurse RN

West Columbia, SC · On-site

Unencumbered current Registered Nurse license in the state where the HomeCare agency is located or ... For further information, please review the Know Your Rights notice from the Department of Labor.

UHS

Registered Nurse RN

West Columbia, SC · On-site

... review current topics within the industry. Having the opportunity to grow, learn, and advance in ... (RN) with UHS. We want to help you succeed and grow in your profession and enjoy a sense of ...

UHS

Registered Nurse RN

West Columbia, SC · On-site

... review current topics within the industry. Having the opportunity to grow, learn, and advance in ... (RN) with UHS. We want to help you succeed and grow in your profession and enjoy a sense of ...

NHC

Registered Nurse RN

Sumter, SC · On-site

NHC knows that care starts with Registered Nurses who are valued and given advancement ... For further information, please review the Know Your Rights notice from the Department of Labor.

Varite

Licensed Practical Nurse #

Columbia, SC · On-site

$21 - $28.50/hr

* Performs medical reviews using established criteria sets and/or performs utilization management of ... Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. Note ...

NHC

RN Registered Nurse

Columbia, SC · On-site

Registered Nurse (RN) Are you looking to make a difference in the lives of others by sharing your ... For further information, please review the Know Your Rights notice from the Department of Labor.

NHC

RN Registered Nurse

Columbia, SC · On-site

Registered Nurse (RN) Are you looking to make a difference in the lives of others by sharing your ... For further information, please review the Know Your Rights notice from the Department of Labor.

NHC

RN Registered Nurse

West Columbia, SC · On-site

Registered Nurse (RN) Are you looking to make a difference in the lives of others by sharing your ... For further information, please review the Know Your Rights notice from the Department of Labor.

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

Utilization Review Rn information

See Columbia, SC salary details

$19

$39

$63

How much do utilization review rn jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for utilization review rn in Columbia, SC is $39.12, according to ZipRecruiter salary data. Most workers in this role earn between $30.91 and $44.90 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $81,362 per year, or $39.1 per hour.
Outcomes Coordinator RN - Surgery

Outcomes Coordinator RN - Surgery

Lexington Medical Center

West Columbia, SC • On-site

Full-time

Medical, Dental, Life, Retirement

Posted 7 days ago

Lexington Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

533rd of 1,020 rated hospitals

Job description

Quality Management - Acute
Full Time
Day Shift
8a-430p
Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.
Lexington Health also includes an accredited Cancer Center of Excellence, the state's first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer's care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.
Job Summary
The Outcomes Coordinator will guide efforts to assess and improve performance and coordinate use of measurement data to monitor, document, and ultimately improve the quality of care and services provided at Lexington Medical Center. Assists in evaluation, analysis, maintenance and development of system functionality of electronic health record (EPIC) to meet clinical objectives including participating in project plan development/tracking and workflow analysis. Responsible for data integrity and follows well defined processes for maintaining data integrity. Serves as expert regarding DNV, SC DHEC and other disease specific regulatory requirements and serves in an active role to achieve compliance to standards.
Minimum Qualifications
Minimum Education: Bachelor of Science in Nursing;
Candidates pursuing ADN to MSN may be considered if they have completed all of the BSN curriculum as verified by the educational institution and complete the MSN within one year of employment or transfer to the role.
Minimum Years of Experience: 5 Years of experience as a registered nurse, including at least 2 years of utilization review, quality assurance, or case management experience and 2 years experience in leadership role.
Substitutable Education & Experience (Optional): Refer to Mandatory Certification Requirements P&P for required education/certification for Coordinator serving on Stroke Team
Required Certifications/Licensure: Currently licensed as Registered Nurse by the State Board of Nursing for South Carolina.
Required Training: None
Essential Functions
  • Facilitate the delivery of quality, cost-effective patient care and the achievement of desired outcomes for patients, families, and the organization by coordinating data collection and analysis for performance improvement activities.
  • Integrates and coordinates performance improvement measurement activities so as to avoid duplication of effort and ensure a comprehensive, patient population-focused strategy.
  • Coordinates continuous readiness activities for DNV and other regulatory requirements in respective areas.
  • Participates in the development, implementation, evaluation, and revision of new programs, protocols, teaching plans, and other guidelines for care of identified patient populations.
  • Provides educational offerings that contribute to the professional development of others (ex. PDCA, PI, DNV requirements).
  • As requested, designs clinical studies utilizing knowledge of research design and statistical methods. Involved in ongoing research related to the care of the ACS patient.

Duties & Responsibilities
  • Performs statistical analysis of data, summarizes findings, and prepares reports. Able to communicate effectively through presentation skills in several formats for different audiences.
  • Implements data collection system which maximize use of existing databases and minimize the need for manually collected data.
  • Utilizes nationally-developed practice guidelines & Benchmarks and other research-based practice recommendations in the selection of the process and outcome indicators to be measured.
  • Participates in data collection. Evaluates and makes recommendations for improving data collection methods and accuracy. Works closely with clinical areas to coordinate and improve data collection.
  • Participates on CQI teams/task forces/committees. Facilitates / leads teams utilizing CQI tools and methods.
  • Develops and maintains performance measurement data collection systems and processes that are accessible, efficient, and retrievable.
  • Functions as change agent by participating and supporting the change management process.
  • Works collaboratively and communicates effectively with administration, IT and clinical care teams through participation in the planning, development, evaluation and maintenance of the Clinical Information Systems.
  • Build professional skills by maintaining awareness of health care environment and information systems technology.
  • Acquires appropriate continuing education credits for own professional development and maintenance of current knowledge of outcomes management and related fields (minimum 25 hours per year).
  • Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:
  • Day ONE medical, dental and life insurance benefits
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance - equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.

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