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Authorization Utilization Review Jobs in Raleigh, NC

Duke Health

Utilization Manager

Durham, NC · On-site

Validates authorization for all bedded patients and commercial initiatives. payer authorization ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke University

Utilization Manager

Durham, NC · On-site

Validates authorization for all bedded patients and commercial initiatives. payer authorization ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke University

Utilization Manager

Durham, NC · On-site

Validates authorization for all bedded patients and commercial initiatives. payer authorization ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

Validates authorization for all bedded patients and commercial initiatives. payer authorization ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

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All JobsAuthorization Utilization Review JobsAuthorization Utilization Review Jobs in Raleigh, NC

Authorization Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do authorization utilization review jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for authorization utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

What is authorization utilization review?

Authorization Utilization Review is a process used by healthcare organizations and insurance companies to assess the medical necessity and appropriateness of medical services before they are provided. The main goal is to ensure that patients receive care that is effective, efficient, and covered by their health plan. This review typically involves evaluating patient records, treatment plans, and provider requests to decide if the requested services meet established guidelines. By doing so, it helps control healthcare costs and ensures quality care for patients.

What are the key skills and qualifications needed to thrive as an authorization utilization review specialist?

To thrive as an Authorization Utilization Review Specialist, you need a solid understanding of medical terminology, healthcare regulations, and insurance policies, often backed by a clinical background or relevant certifications. Familiarity with utilization management software, electronic health records (EHR), and payer portals is typically required. Strong attention to detail, analytical thinking, and effective communication are vital soft skills for coordinating with providers and payers. These skills ensure accurate authorization decisions, regulatory compliance, and efficient patient care coordination.

What are some common challenges faced by professionals in authorization utilization review roles, and how can they be addressed?

Professionals in Authorization Utilization Review often encounter challenges such as managing high caseloads, navigating complex insurance guidelines, and ensuring timely communication with providers and patients. Staying organized and up-to-date with evolving payer requirements is essential to avoid delays or denials. Building strong collaboration with clinical teams and leveraging electronic health record systems can help streamline workflows and improve efficiency in the review process.

What is the difference between Authorization Utilization Review vs Claims Reviewer?

AspectAuthorization Utilization ReviewClaims Reviewer
CredentialsTypically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionalsOften requires similar credentials, focusing on insurance policies and claims processing
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, third-party administrators, healthcare organizations
Industry UsageUsed to assess medical necessity before approving servicesUsed to evaluate claims for payment accuracy and compliance

Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.

What are popular job titles related to Authorization Utilization Review jobs in Raleigh, NC?

For Authorization Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Authorization Utilization Review jobs in Raleigh, NC look for?

The top searched job categories for Authorization Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Authorization Utilization Review jobs?

Cities near Raleigh, NC with the most Authorization Utilization Review job openings:

Authorization Utilization Review jobs near you
Infographic showing various Authorization Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 25% As Needed, and 75% Full Time. Highlights an 100% In-person job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Per diem

Re-posted 12 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Position Summary:

Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.

Qualifications:

North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.

What Granville Health System employees say

Pay

Hours and flexibility

Workplace

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