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Director Remote Utilization Review Jobs in Raleigh, NC

Red Oak Recovery Center

Clinical Director

Durham, NC · Remote

$90K - $100K/yr

We are seeking a Clinical Director to add to our dynamic team. This position will support our ... Participate in utilization review meetings, representing patient needs in both clinical and ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Raleigh, NC · On-site +1

$51 - $62.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Aprio

Senior Director, Resource Management

Raleigh, NC · On-site +1

$225K - $300K/yr

Analyze trends in utilization, availability, backlog, pipeline, and seasonal demand to drive timely ... remote and hybrid options What's in it for you: - Working with an industry leader : Be part of a ...

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All JobsDirector Remote Utilization Review JobsDirector Remote Utilization Review Jobs in Raleigh, NC

Director Remote Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do director remote utilization review jobs pay per hour?

As of Jun 27, 2026, the average hourly pay for director remote 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 the difference between Director Remote Utilization Review vs Utilization Review Nurse?

AspectDirector Remote Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, advanced degree, and management experienceRegistered Nurse (RN) license, relevant clinical experience
Work EnvironmentOversees teams remotely, strategic planning, policy developmentConducts patient reviews, collaborates with healthcare providers, often remote or onsite
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare facilities

The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.

What is a Director of Remote Utilization Review?

A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.

How does a Director of Remote Utilization Review typically collaborate with clinical and administrative teams to ensure effective patient care management?

A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.

What are the key skills and qualifications needed to thrive as a Director of Remote Utilization Review, and why are they important?

To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.
What are the most commonly searched types of Remote Utilization Review jobs in Raleigh, NC? The most popular types of Remote Utilization Review jobs in Raleigh, NC are:
What are popular job titles related to Director Remote Utilization Review jobs in Raleigh, NC? For Director Remote Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Director Remote Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Director Remote Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Director Remote Utilization Review jobs? Cities near Raleigh, NC with the most Director Remote Utilization Review job openings:
Director Remote Utilization Review jobs near you
Infographic showing various Director Remote Utilization Review job openings in Raleigh, NC as of June 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Drug Utilization Review Pharmacist

Pharmacy Careers

Raleigh, NC • On-site, Remote

Other

Medical

Posted 6 days ago

Job description

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications
A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care.
Key Responsibilities

  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health plan requirements.
  • Contribute to quality improvement initiatives and pharmacy program development.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication.


Why This Role?

  • Impact: Shape prescribing decisions that affect thousands of patients.
  • Growth: Build expertise in managed care and population health pharmacy.
  • Flexibility: Many DUR roles offer hybrid or fully remote schedules.
  • Rewards: Competitive salary, benefits, and career advancement opportunities.


About Us
We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations.
Apply Today
Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

Apply