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Chart Utilization Review Jobs in Raleigh, NC (NOW HIRING)

Duke Health

Utilization Manager

Durham, NC · On-site

... utilization review outcomes with current rules and regulatory requirements. Supports the ... medical chart audit process by ensuring accurate, timely, and informative clinical review ...

Duke Health

Utilization Manager

Durham, NC · On-site

... utilization review outcomes with current rules and regulatory requirements. Supports the ... medical chart audit process by ensuring accurate, timely, and informative clinical review ...

Duke University

Utilization Manager

Durham, NC

... utilization review outcomes with current rules and regulatory requirements. Supports the ... medical chart audit process by ensuring accurate, timely, and informative clinical review ...

Duke University

Utilization Manager

Durham, NC · On-site

... utilization review outcomes with current rules and regulatory requirements. Supports the ... medical chart audit process by ensuring accurate, timely, and informative clinical review ...

Duke Health

Utilization Manager

Durham, NC · On-site

... utilization review outcomes with current rules and regulatory requirements. Supports the ... medical chart audit process by ensuring accurate, timely, and informative clinical review ...

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Communicates with treatment team to ensure chart compliance * Interfaces with others to ensure ... Work with the business office and the utilization review department to ensure payment for services

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Communicates with treatment team to ensure chart compliance * Interfaces with others to ensure ... Work with the business office and the utilization review department to ensure payment for services

Lifepoint Health

Office Coordinator

Raleigh, NC

$15.50 - $20.50/hr

Communicates with treatment team to ensure chart compliance * Interfaces with others to ensure ... Work with the business office and the utilization review department to ensure payment for services

Centerwell

Clinical Care Nurse Educator

Raleigh, NC · On-site

... chart review, data review, and provide guidance to ensure that the quality of care being provided meets appropriate standards and to ensure cost-effective utilization practices for new and current ...

STV

Senior Scheduler (Civil Engineering)

Raleigh, NC · On-site

Prepare Basis of Schedule in accordance with client requirements; review construction design ... Position duties require extensive utilization of P6 Enterprise Project Portfolio Management ...

Verdesian

Cost Accountant

Cary, NC · On-site

$61K - $81K/yr

... utilization, etc. * Posting all relevant accounting journal entries * Creation, analysis and ... Maintain general ledger and chart of accounts * Assist with preparation of audit reports and ...

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Chart Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do chart utilization review jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for chart 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 chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

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

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

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

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

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

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

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Manager

Durham, NC • On-site

Duke Health

7.3

Company rating: 7.3 out of 10

Based on 255 frontline employees who took The Breakroom Quiz

305th of 894 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Duke Healthexternal

Full-time

Re-posted 20 days ago

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke University Hospital
Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.
Duke Nursing Highlights:
  • Duke University Health System is designated as a Magnet organization
  • Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 Nurses.
  • Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy for being strong advocates of specialty nursing certification.
  • Duke University Health System has 6000 + registered nurses
  • Quality of Life: Living in the Triangle!
  • Relocation Assistance (based on eligibility)

Work Hours:4/10s every other weekend
Assesses for accuracy in the assignment of patient class (status) to reflect congruence with clinical condition, physician intent, and utilization review outcomes with current rules and regulatory requirements. Supports the medical chart audit process by ensuring accurate, timely, and informative clinical review documentation that supports the medical necessity/level of care. Supports denials management by documenting activities related to denials adjudication according to departmental guidelines and actively works to overturn threatened denial activities. Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team to address, understand, and mitigate excess/avoidable days. Serves as primary source of consultation for issues related to patient class (status) determination.
Work Performed
  • Validates authorization for all bedded patients and commercial initiatives. payer authorization within the contractual timeframe at time of presentation, every third day or as needed (e.g. ED, Direct Admit, Transfers).
  • Manage concurrent cases to resolution care that may impact payer approval to authorize care as medically necessary.
  • Conducts initial review and continued stay reviews as designated in UM plan.
  • Reviews records for medical necessity and collaborates with physician (s) and members of the care team to validate information.
  • Establishes and communicates estimated LOS and expected discharge date using GMLOS.
  • Utilizes an evidenced-based clinical review screening criteria as a guide to support medical necessity determinations and refers cases with failed criteria to the Physician Advisor or appeals as necessary in accordance with the UM plan.
  • Facilitates mitigation of denials and peer to peer conversations.
  • Collaborates with CM, CSW, Physicians, and Care Team to enhance communication related to discharge planning and utilization management.
  • Ongoing collaboration with Case Manager to ensure that patient's condition meets medical necessity criteria and communicate changes that could affect the discharge plan of care.
  • Confirms that orders reflect the patient's billing patient status in accordance with the UM plan. Partners with internal Physician Advisors, as well as compliance and revenue cycle partners, within the health system to a safeguard processes and expected outcomes.
  • Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan.
  • Gives feedback as requested to enhance negotiations with payors.
  • Develops and maintains positive relationships with customers internal and external to Duke Health System.
  • Maintains effective communication with health care team members related to care coordination and utilization management.
  • Contributes to a positive working environment and performs other duties as assigned/directed to enhance the overall efforts for the organization.
  • Actively participates in a hospital committee.
  • Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines for all short-stay Medicare inpatients and outpatients (DUH), all observation encounters, all combined/segmental billing encounter questions, and any encounter sent to the UM MCA from PRMO for patient status/post-bill medical necessity denials/coding questions. Reviews and, when appropriate, completes as written appeal for post-bill regulatory agency and Medicare advantage medical necessity audits.
  • Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM screening and assessment for high-risk, potential readmits, and admitted patient encounters.
  • Collaborate with ED treatment team to prevent inappropriate admissions by facilitating community referrals and making post-dc arrangements, as appropriate. Works collaboratively with inpatient case management to support transitions from ED to inpatient.

Knowledge, Skills and Abilities
  • Basic computer proficiency required
  • Ability to become proficient in the navigation and interpretation of an electronic health record.
  • Work effectively in a self-directed role, multi-task, capable of daily problem-solving complex issues.
  • Excellent written and verbal skills
  • Basic proficiency in the use of Microsoft Word, Power Point and Excel

Level Characteristics
N/A
Minimum Qualifications
Education
BSN required
Experience
Minimum of three years recent acute clinical practice or related health care experience.
Degrees, Licensures, Certifications
Requires Case Management Certification (ACM, CCM or ANCC) within 2 years of hire. BSN required and must have current or compact RN licensure in state of NC. BLS certification required.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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