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Contract Utilization Review Nurse Jobs in Raleigh, NC

Duke Health

Utilization Manager

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 ...

Duke University

Utilization Manager

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 ...

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All JobsContract Utilization Review Nurse JobsContract Utilization Review Nurse Jobs in Raleigh, NC

Contract Utilization Review Nurse information

See Raleigh, NC salary details

$20

$41

$67

How much do contract utilization review nurse jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for contract utilization review nurse 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 a contract utilization review nurse?

A Contract Utilization Review Nurse is a registered nurse who works on a contractual basis to review medical records and health care services for appropriateness, necessity, and efficiency. Their primary role is to ensure that patients receive the right care while helping healthcare organizations comply with regulations and control costs. These nurses often work for insurance companies, hospitals, or third-party review organizations, and they assess requests for medical procedures, hospital admissions, and ongoing treatments. They use established guidelines and clinical criteria to make determinations and frequently interact with healthcare providers to gather additional information. Contract positions may offer flexibility and the opportunity to work remotely.

What are the key skills and qualifications needed to thrive as a contract utilization review nurse?

To thrive as a Contract Utilization Review Nurse, you need a current RN license, strong clinical knowledge, and experience in medical record review and case management. Familiarity with utilization management software, InterQual or MCG guidelines, and health insurance regulations is typically required. Excellent analytical thinking, attention to detail, and effective communication skills help in collaborating with providers and ensuring compliance. These abilities are essential for delivering accurate utilization reviews, optimizing patient outcomes, and supporting cost-effective healthcare operations.

What are some common challenges faced by contract utilization review nurses, and how can they be addressed?

Contract Utilization Review Nurses often face the challenge of managing high caseloads while maintaining accuracy and timeliness in their reviews. Working remotely or across multiple facilities can require strong organizational skills and effective communication with interdisciplinary teams. Adapting quickly to different payer guidelines and documentation systems is also essential. Staying current with changes in healthcare regulations and leveraging technology can help overcome these challenges, ensuring both compliance and quality patient care.

What is the difference between Contract Utilization Review Nurse vs Utilization Review Nurse?

AspectContract Utilization Review NurseUtilization Review Nurse
CredentialsRN license, certification in case management or utilization review often preferredRN license, certification in case management or utilization review often preferred
Work EnvironmentTypically contracted for specific projects or timeframes, often remote or in healthcare facilitiesUsually employed full-time by healthcare organizations, hospitals, or insurance companies
Employer & Industry UsageContract agencies, healthcare facilities, insurance companiesHospitals, insurance companies, healthcare organizations

The main difference is that Contract Utilization Review Nurses work on a temporary, contract basis, often through agencies, while Utilization Review Nurses are usually employed full-time by healthcare or insurance organizations. Both roles require similar credentials and focus on reviewing medical necessity and appropriateness of care.

What are the most commonly searched types of Utilization Review Nurse jobs in Raleigh, NC?

The most popular types of Utilization Review Nurse jobs in Raleigh, NC are:

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

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

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

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

Contract Utilization Review Nurse jobs near you
Infographic showing various Contract Utilization Review Nurse job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote 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 2 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

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