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Utilization Review Jobs in Charleston, SC (NOW HIRING)

MUSC

Nurse Case Manager l - PRN

Charleston, SC · On-site

May also be responsible for conducting utilization reviews. Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and three years work experience as a ...

MUSC

Case Manager - Non RN

Charleston, SC · On-site

One year of case management and/or utilization review work experience preferred. Case Management certification preferred. Licensure as a Social Worker by the state of South Carolina. If you like ...

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Utilization Review information

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$40

$65

How much do utilization review jobs pay per hour?

As of Aug 25, 2026, the average hourly pay for utilization review in Charleston, SC is $40.14, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.11 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Charleston, SC?

The most popular types of Utilization Review jobs in Charleston, SC are:

What are popular job titles related to Utilization Review jobs in Charleston, SC?

For Utilization Review jobs in Charleston, SC, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Charleston, SC look for?

The top searched job categories for Utilization Review jobs in Charleston, SC are:

What cities near Charleston, SC are hiring for Utilization Review jobs?

Cities near Charleston, SC with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Charleston, SC as of August 2026, with employment types broken down into 65% Full Time, 32% Part Time, and 3% Contract. Highlights an 87% In-person, and 13% Remote job distribution, with an average salary of $83,498 per year, or $40.1 per hour.

Utilization Review Nurse

North Charleston, SC • On-site

Careers Integrated Resources Inc
See more jobs at Careers Integrated Resources Incexternal

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This job post has expired 5 days ago. Applications are no longer accepted.

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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