Oxford, NC · Hybrid
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Oxford, NC · Hybrid
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Oxford, NC · On-site
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Oxford, NC · On-site
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Oxford, NC · Hybrid
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Oxford, NC · Hybrid
Medical
Dental
Vision
Life
Retirement
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Raleigh, NC · On-site
... case management, home health, discharge planning, or Concurrent review. Qualifications · RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree. · Minimum of 3 years ...
New
Raleigh, NC · On-site
... case management, home health, discharge planning, or Concurrent review. Qualifications · RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree. · Minimum of 3 years ...
New
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Chapel Hill, NC · On-site
$2.2K/wk
Medical
Dental
Vision
Life
Retirement
AMN Healthcare Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chapel Hill, North Carolina. & Requirements * Specialty: Utilization Review
Chapel Hill, NC · On-site
$2.2K/wk
Medical
Dental
Vision
Life
Retirement
AMN Healthcare Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chapel Hill, North Carolina. & Requirements * Specialty: Utilization Review
Chapel Hill, NC · On-site
$2.2K/wk
Medical
Dental
Vision
Life
Retirement
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chapel Hill, North Carolina. & Requirements * Specialty: Utilization Review
Chapel Hill, NC · On-site
$2.2K/wk
Medical
Dental
Vision
Life
Retirement
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chapel Hill, North Carolina. & Requirements * Specialty: Utilization Review
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and ... Certification in Case Management (CCM or ACM) is preferred. Experience: Ideally, candidates will ...
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and ... Certification in Case Management (CCM or ACM) is preferred. Experience: Ideally, candidates will ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... ensure timely review of services and care. * Provides referrals to Case management, Disease ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in ... ensure timely review of services and care. * Provides referrals to Case management, Disease ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Durham, NC · On-site
Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...
Chapel Hill, NC · On-site
RN - Care Manager | Chapel Hill, NC Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8 ... Conduct utilization review and case management activities. * Participate in daily Care Management ...
Chapel Hill, NC · On-site
RN - Care Manager | Chapel Hill, NC Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8 ... Conduct utilization review and case management activities. * Participate in daily Care Management ...
Chapel Hill, NC · On-site
RN - Care Manager | Chapel Hill, NC Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8 ... Conduct utilization review and case management activities. * Participate in daily Care Management ...
Chapel Hill, NC · On-site
RN - Care Manager | Chapel Hill, NC Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8 ... Conduct utilization review and case management activities. * Participate in daily Care Management ...
... review of services and care. • Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. • Develop and review member centered ...
... review of services and care. • Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. • Develop and review member centered ...
Chapel Hill, NC · On-site +1
... review of services and care. • Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. • Develop and review member centered ...
Chapel Hill, NC · On-site +1
... review of services and care. • Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. • Develop and review member centered ...
Chapel Hill, NC · On-site
$2.0K/wk
Nursing Diploma or ADN/ASN from an accredited school of Nursing Must-Have ... DISCHARGE PLANNING CRITICAL THINKING CASE MANAGEMENT UTILIZATION REVIEW PATIENT ASSESSMENT ...
Chapel Hill, NC · On-site
$2.0K/wk
Nursing Diploma or ADN/ASN from an accredited school of Nursing Must-Have ... DISCHARGE PLANNING CRITICAL THINKING CASE MANAGEMENT UTILIZATION REVIEW PATIENT ASSESSMENT ...
$18.69 - $24.07
3% of jobs
$24.07 - $29.44
6% of jobs
$34.31 is the 25th percentile. Wages below this are outliers.
$29.44 - $34.82
17% of jobs
$34.82 - $40.19
20% of jobs
The median wage is $41.27 / hr.
$40.19 - $45.57
16% of jobs
$45.57 - $50.94
11% of jobs
$52.09 is the 75th percentile. Wages above this are outliers.
$50.94 - $56.32
7% of jobs
$56.32 - $61.69
6% of jobs
$61.69 - $67.06
5% of jobs
$67.06 - $72.44
4% of jobs
$72.44 - $77.81
3% of jobs
$18
$46
$77
| Aspect | Case Manager Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community health, insurance providers |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating patient care and discharge planning |
While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.
Full-time
Medical, Dental, Vision, Life, Retirement
Re-posted 25 days ago
8.6
Based on 5 frontline employees who took The Breakroom Quiz
Case Manager - Utilization Review
Location: Granville Health System, Oxford NC
About Granville Health System:
For over a century, Granville Health System has been at the forefront of quality healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.
About Oxford, NC
Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters—perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.
Position Overview:
The primary role of the Case Manager is to review and monitor members’ utilization of health care services with the goal of maintaining high quality, cost-effective care. This role will provide the medical and utilization review expertise necessary to evaluate patient status. This includes reviewing clinical information against established criteria, assessing the medical necessity of services and procedures, collaborating with providers and interdisciplinary teams, and ensuring that the patient is placed at the appropriate level of care from the time of admission. This includes providing referral authorization, concurrent review, proactive discharge/transition planning, appropriate referral to case management, and high-dollar claims review.
Position Highlights:
Key Responsibilities:
• Conduct concurrent review of all patients, regardless of payer source, using approved screening criteria
• Perform admission reviews on the first working day following admission
• Conduct continued stay reviews at least every three (3) days or more frequently as indicated
Qualifications
Associate degree in a healthcare-related field or equivalent combination of healthcare experience and education.
At least a year of experience in a related role (utilization review, case management, care coordination, insurance authorization/prior authorization, clinical documentation review, hospital patient access or revenue cycle support, healthcare quality or compliance functions).
Strong attention to detail, organizational skills and interpersonal skills. Ability to interpret clinical documentation and apply review criteria. Strong communication skills for interaction with physicians and interdisciplinary teams. Knowledge of healthcare regulations and payer requirements
Preferred
Bachelor’s degree in Health Administration, Public Health, Social Work, Healthcare Management, or related field. Accredited Case Manager (ACM) certification.
Experience with insurance authorization criteria preferred; one year utilization and discharge planning experience.
Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.
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