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

Southeastern College

Nursing Faculty-RN

Columbia, SC

Review the Course Control Document (CCD) * Prepare the course syllabus based on the CCD to meet the ... Meet departmental standards for classroom management, utilization of technology, and records ...

Southeastern College

Nursing Faculty-RN

Columbia, SC · On-site

Review the Course Control Document (CCD) * Prepare the course syllabus based on the CCD to meet the ... Meet departmental standards for classroom management, utilization of technology, and records ...

Southeastern College

Nursing Faculty-RN

Columbia, SC · On-site

Review the Course Control Document (CCD) * Prepare the course syllabus based on the CCD to meet the ... Meet departmental standards for classroom management, utilization of technology, and records ...

Wvumedicine

Care Manager RN - Peak Health

Peak, SC · Hybrid

EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state ... delegation. 2. Perform utilization management reviews as needed according to accepted and ...

NHC

Registered Nurse, RN PRN - Caris Sumter

Sumter, SC · On-site

$30 - $45/hr

Position: Registered Nurse, RN PRN Pay: $30.00 - $45.00 / hourly Depending On Experience and ... 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.
Clinical MDS Reimbursement Specialist

Clinical MDS Reimbursement Specialist

Lutheran Homes of South Carolina

Irmo, SC • On-site

Full-time

Re-posted 6 days ago

Job description

The Clinical Reimbursement / MDS Specialist will be responsible for performing chart audits, systems development and implementation of programs that apply to the Resident Assessment Instrument (RAI), Prospective Payment Systems (PPS) and Quality Measures (QM's).
  • Associates Degree
  • Must be a RN, licensed to practice in the State of South Carolina.
  • Minimum of two (2) years nursing experience
  • Minimum of (2) years of MDS experience
  • RAC certification
  • Have knowledge of current state and federal regulations, particularly the following pertinent sections of Appendix PP: 483.20 Resident Assessments and 483.21 Comprehensive Resident Centered Care Plans
  • Experience with Excel, Word and other Microsoft office programs
  • Ability to manage multiple projects simultaneously
  • Detailed oriented and strong problem solving skills
  • Excellent verbal and written communication skills

Apply