One year utilization and review experience ... Experience with MCG authorization criteria preferred. Knowledge of current nursing principles ...
One year utilization and review experience ... Experience with MCG authorization criteria preferred. Knowledge of current nursing principles ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience ... Experience with MCG authorization criteria preferred. Knowledge of current nursing principles ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience ... Experience with MCG authorization criteria preferred. Knowledge of current nursing principles ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville ... This includes providing referral authorization, concurrent review, proactive discharge/transition ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville ... This includes providing referral authorization, concurrent review, proactive discharge/transition ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville ... This includes providing referral authorization, concurrent review, proactive discharge/transition ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville ... This includes providing referral authorization, concurrent review, proactive discharge/transition ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Be Seen First
Clinical Pharmacist - Prior Authorization (278644)
Durham, NC · On-site
$59 - $63/hr
Review and summarize daily utilization review data and prepare reports for corporate compliance ... Review prior authorization and non-formulary drug guidelines to support Pharmacy & Therapeutics ...
Quick apply
Be Seen First
Clinical Pharmacist - Prior Authorization (278644)
Durham, NC · On-site
$59 - $63/hr
Review and summarize daily utilization review data and prepare reports for corporate compliance ... Review prior authorization and non-formulary drug guidelines to support Pharmacy & Therapeutics ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Prior Authorization Clinical Pharmacist
Durham, NC · On-site
$114K - $136K/yr
Prior Authorization Clinical Pharmacist Prior Authorization Clinical Pharmacist Virtual: This role ... This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug ...
Prior Authorization Clinical Pharmacist
Durham, NC · On-site
$114K - $136K/yr
Prior Authorization Clinical Pharmacist Prior Authorization Clinical Pharmacist Virtual: This role ... This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug ...
Prior Authorization Clinical Pharmacist
Durham, NC · On-site
$114K - $136K/yr
This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug ... Prior Authorization experience preferred. * Specialty Medication experience preferred. Unless ...
Prior Authorization Clinical Pharmacist
Durham, NC · On-site
$114K - $136K/yr
This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug ... Prior Authorization experience preferred. * Specialty Medication experience preferred. Unless ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · On-site +1
Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ... Implement a system to maintain and assure that the authorization of services provided by clinical ...
Dir-Utilization Management-Physical Health (Full-time Remote, Morrisville, NC Based)
Morrisville, NC · On-site +1
Oversee the UM Unit reviewing physical health services * Ensure consistent application of medical ... Implement a system to maintain and assure that the authorization of services provided by clinical ...
Authorization Utilization Review information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do authorization utilization review jobs pay per hour?
As of Jul 21, 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 are the key skills and qualifications needed to thrive as an Authorization Utilization Review Specialist, and why are they important?
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?
| Aspect | Authorization Utilization Review | Claims Reviewer |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionals | Often requires similar credentials, focusing on insurance policies and claims processing |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Insurance companies, third-party administrators, healthcare organizations |
| Industry Usage | Used to assess medical necessity before approving services | Used 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 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 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:
- Remote Utilization Management
- Remote Prior Authorization Nurse
- Behavioral Health Utilization Review
- Utilization Management
- Night Utilization Review Nurse
- Evening Utilization Review Nurse
- Evening Optum Health Utilization Review
- Full Time Appeals Nurse Remote
- Medical Review Nurse
- Contract Utilization Review Nurse
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:
Granville Health System rating
8.6
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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