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Authorization Utilization Review Jobs in Raleigh, NC

Omega Solutions Inc

Pharmacist

Raleigh, NC · On-site

... Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and ...

Integrated Resources

RN-Care Manager

Chapel Hill, NC · On-site

Perform case management, utilization review, and discharge planning activities. * Review daily ... Identify authorization requirements for post-discharge services and coordinate referrals. * Support ...

360X Staffing

Medical Director

Morrisville, NC · On-site

... utilization management, and care coordination. Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including authorization of services and ...

360X Staffing

Medical Director

Morrisville, NC · On-site

... utilization management, and care coordination. Clinical Oversight & Medical Review Provide expert guidance and oversight for physical health service requests, including authorization of services and ...

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Showing results 21-40

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.

RN-Care Manager

Careers Integrated Resources Inc

Chapel Hill, NC • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

RN – Care Manager | Chapel Hill, NC

Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8:00 AM – 5:00 PM

Job Summary

The RN Care Manager is responsible for coordinating patient care through comprehensive assessment, care planning, utilization review, discharge planning, and care transitions. This role focuses on improving patient outcomes, ensuring continuity of care, and promoting cost-effective treatment for acutely ill patients in an acute care hospital setting.

Key Responsibilities
  • Perform comprehensive patient assessments and develop individualized care plans.
  • Coordinate discharge planning and transition of care.
  • Conduct utilization review and case management activities.
  • Participate in daily Care Management Touchpoint (CAPP) meetings.
  • Attend weekly Complex Care Meetings (CCM) and collaborate on high-risk cases.
  • Identify and address barriers to discharge.
  • Coordinate with physicians, social workers, utilization managers, and multidisciplinary teams.
  • Educate patients and families regarding discharge plans and community resources.
  • Arrange post-acute services and obtain necessary authorizations.
  • Document assessments and care plans in Epic.
  • Monitor patient progression and expected discharge dates (EDD).
Required Qualifications
  • Active Registered Nurse (RN) license.
  • Minimum 2 years of healthcare experience as a Registered Nurse.
  • Recent Acute Care Hospital Case Management/Care Management/Discharge Planning experience.
  • Strong patient assessment and critical thinking skills.
  • Experience coordinating multidisciplinary care teams.
  • Proficiency with Epic EMR is preferred.
Must-Have Experience
  • Acute Care Hospital
  • RN Case Manager
  • Care Manager
  • Discharge Planning
  • Utilization Review
  • Care Coordination
  • Transition of Care
  • Complex Case Management
  • Interdisciplinary Collaboration
  • Epic Documentation

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