Utilization Review Nurse Specialist

7 days ago


Columbia, South Carolina, United States US Tech Solutions, Inc. Full time

Join US Tech Solutions, Inc. as a Utilization Review Nurse Specialist and be part of a dynamic team that delivers innovative solutions to the healthcare industry.

About the Role

We are seeking an experienced RN with a strong background in utilization review and case management to join our team. As a Utilization Review Nurse Specialist, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.

Key Responsibilities
  • Evaluate medical necessity and make informed decisions regarding service authorization and denials.
  • Collaborate with healthcare providers and facilities to develop effective discharge plans and assess service needs.
  • Ensure accurate documentation of clinical information to support medical necessity criteria and contract benefits.

As a Utilization Review Nurse Specialist, you will have the opportunity to work closely with our healthcare professionals to manage the complex needs of our members. You will be responsible for:

Medical Necessity Reviews
  • Evaluate medical records and perform comprehensive reviews to determine medical necessity.
  • Apply clinical expertise and knowledge of healthcare continuum to assess and plan services.
  • Develop and implement individualized plans to promote quality, cost-effective outcomes.

You will also be responsible for:

Care Coordination
  • Assess service needs and develop effective discharge plans in collaboration with healthcare providers and facilities.
  • Promote enrollment in care management programs and health and disease management programs.
  • Maintain current knowledge of contracts and network status of all service providers.

We offer a competitive salary of $**$80,000 - $110,000 per year**, depending on experience, plus excellent benefits and opportunities for professional growth.

This is a full-time position working from home with occasional travel required. If you are a motivated and detail-oriented RN with excellent communication skills, we encourage you to apply.



  • West Columbia, South Carolina, United States Lexington Medical Center Full time

    Company OverviewLexington Medical Center is a leading healthcare provider in the Columbia metro area, consistently ranked #1 by U.S. News & World Report. Our commitment to quality health services and community dedication makes us an ideal workplace for professionals seeking a challenging and rewarding career. Salary: $65,000 - $90,000 per year Job...


  • Columbia, South Carolina, United States Prisma Health Full time

    At Prisma Health, we're transforming healthcare for the benefit of our communities. As a Healthcare Utilization Specialist, you'll play a vital role in shaping the future of healthcare.About the RoleWe're seeking an experienced professional to join our team as a Healthcare Utilization Specialist. This is a dynamic opportunity to work with a talented group of...


  • Columbia, South Carolina, United States Nurse First Full time

    OverviewNurse First Travel Agency is a leading provider of travel nursing services, dedicated to giving nurses the best experience possible. With a commitment to advocacy and support, we strive to make every assignment a fulfilling and enjoyable experience.In this role, you will have the opportunity to work as a Medical Imaging Specialist in Richland,...

  • Medical Review RN

    7 days ago


    West Columbia, South Carolina, United States InGenesis Full time

    Job Title: Medical Review RNAbout the Role: InGenesis is seeking a skilled Registered Nurse to join our team as a Medical Review RN. This role involves reviewing and evaluating medical eligibility for benefits, assessing medical necessity, and monitoring services to ensure they align with benefit guidelines.Responsibilities:Perform medical...


  • Columbia, South Carolina, United States Nurse First Full time

    Nurse First is seeking a skilled Diagnostic Imaging Specialist to join their team for a travel assignment in South Carolina.About the RoleWe are looking for an experienced Diagnostic Imaging Specialist to work as a CT Technologist. The successful candidate will be responsible for operating imaging equipment, preparing patients for procedures, and maintaining...


  • Columbia, South Carolina, United States Nurse First Full time

    We are seeking a skilled Mobile Diagnostic Imaging Specialist to join our team in Washington. This is an exciting opportunity for the right individual to work with us and make a difference in the lives of our patients.About the JobAs a Mobile Diagnostic Imaging Specialist, you will be responsible for performing diagnostic imaging procedures using various...


  • Columbia, South Carolina, United States Travel Nurse Across America Full time

    Job SummaryWe are seeking a highly skilled Critical Care Travel Nurse RN Specialist to join our team at Travel Nurse Across America. As a travel nurse, you will have the opportunity to work in various locations across the country, providing exceptional patient care and developing your skills in a dynamic environment.About the RoleThe ideal candidate will...


  • Columbia, South Carolina, United States Nurse First Full time

    About Nurse First">Nurse First Travel Agency is committed to providing the best experience possible for travel nurses. Our company's founder was a nurse first, and at our roots, we believe nurses need advocates to help them have the best experience possible.">Our Mission">We want our travel nurses to focus on taking care of their patients while experiencing...


  • Columbia, South Carolina, United States Nurse First Full time

    Nurse First is seeking a skilled Diagnostic Imaging Specialist to join their team in Washington.Job OverviewWe are committed to providing our travel nurses with the best experience possible. Our company's founder was a nurse first, and at our roots, we believe nurses need advocates to help them have the best experience possible. That's where we come in. We...


  • Columbia, South Carolina, United States Travel Nurse Across America Full time

    Job SummaryWe are seeking a skilled Cardiac Care Specialist to join our team at Travel Nurse Across America. This exciting opportunity is based in Columbia, SC and offers the chance to work with a dynamic group of healthcare professionals.About the RoleThe successful candidate will provide high-quality patient care in a fast-paced Progressive Care Unit (PCU)...


  • Columbia, South Carolina, United States Prisma Health Full time

    At Prisma Health, we're transforming healthcare for the benefit of our communities. As a Critical Care Nurse Specialist in our Surgical Trauma Intensive Care Unit, you'll play a vital role in providing exceptional patient care.About the RoleWe're seeking a highly skilled and compassionate Registered Nurse to join our team. In this critical care nurse...


  • Columbia, South Carolina, United States Nurse First Full time

    Nurse First, a pioneering travel agency committed to empowering nurses, is seeking an experienced Per Diem Ultrasound Specialist for a challenging opportunity in Richland, Washington. Job OverviewThis 13-week assignment requires working 40 hours per week, with a shift duration of 10 hours, spread across days.The successful candidate will join our esteemed...


  • Columbia, South Carolina, United States Nurse First Full time

    Job OpportunityNurse First is seeking a skilled Diagnostic Imaging Specialist for a travel assignment in Washington State.About the JobThis 13-week contract will require 40 hours of work per week, with shifts spanning 10 hours. The ideal candidate will possess strong clinical skills and excellent communication abilities.ResponsibilitiesPerform diagnostic...


  • Columbia, South Carolina, United States Nurse First Full time

    Job SummaryNurse First is seeking a skilled Registered Respiratory Therapist to join our team for a travel assignment in Richland, Washington.About the AssignmentDurational: 13 weeksHours per week: 36 hoursShift: 12 hours, nightsThe ideal candidate will possess excellent clinical skills and be comfortable working in a fast-paced environment. As a Mobile...


  • Columbia, South Carolina, United States Midlands Neurology and Pain Associates, P.A. Full time

    Medical Billing Specialist Position Overview At Midlands Neurology and Pain Associates, P.A., we are seeking a highly skilled Medical Billing Specialist to join our team. As a Medical Billing Specialist, you will be responsible for managing all aspects of billing, including accounts receivables, claims submission, and payment posting. You will work closely...

  • Nurse Specialist

    2 days ago


    Columbia, South Carolina, United States Qualivis Prisma Richland Hospital Full time

    About Our TeamAt Qualivis / Prisma Richland Hospital, we value our nurses as essential members of the healthcare team, providing expert care to our patients and supporting each other in our pursuit of excellence.Job SummaryThis Nurse Specialist role is responsible for delivering high-quality patient care in the PCU/Stepdown unit, utilizing evidence-based...


  • Columbia, South Carolina, United States Prisma Health Full time

    At Prisma Health, we are committed to transforming healthcare for the benefit of our communities.We are seeking a talented Registered Nurse to join our team as a Nurse Care Specialist in our Acute Care of the Elderly department at Richland Hospital.About the RoleThis is a rewarding opportunity to make a difference in the lives of our patients and their...


  • Columbia, South Carolina, United States Prisma Health Full time

    At Prisma Health, we strive to transform healthcare for the benefit of our communities. Our team of dedicated professionals is committed to delivering exceptional patient care.Job Summary:We are seeking a Registered Nurse Specialist to join our Family Beginnings department at 1510 Richland Hospital in Columbia, SC.The successful candidate will have a strong...


  • Columbia, South Carolina, United States Prisma Health Full time

    Job Summary:Inspire health as a Cardiac Nursing Specialist at Prisma Health. This role requires providing direct and indirect nursing care to assigned patients under the supervision of the Nurse Manager or designee.About Us:Our vision is simple: to transform healthcare for the benefits of the communities we serve. We are looking for talented individuals like...


  • Columbia, South Carolina, United States SENTA Partners Full time

    Overview">SENTA Partners is a leading healthcare organization dedicated to providing exceptional patient care and innovative solutions. We are seeking a highly skilled Perioperative Registered Nurse Specialist to join our team.About the Role">This dynamic role involves providing comprehensive preoperative assessment and recovery care to surgical patients. As...