Morrisville, NC · On-site
$110 - $150/hr
Manage and develop staff to maintain a qualified workforce * Collaborate with the Director of Behavioral Health Utilization Management Requirements * Bachelors in Nursing with 7 years' post-degree ...
Morrisville, NC · On-site
$110 - $150/hr
Manage and develop staff to maintain a qualified workforce * Collaborate with the Director of Behavioral Health Utilization Management Requirements * Bachelors in Nursing with 7 years' post-degree ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Director (MD) for medical director oversight and necessity determinations. • Communicates ...
Durham, NC · On-site
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Durham, NC · On-site
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Durham, NC · On-site
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Durham, NC · On-site
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
Supports denials management by documenting activities related to denials adjudication according to ... ED, Direct Admit, Transfers). * Manage concurrent cases to resolution care that may impact payer ...
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Oxford, NC · On-site
... to Director when needed. Screens all cases against high risk screens for discharge planning ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Morrisville, NC · Hybrid
$211K - $269K/yr
Ensure the integrity and quality of utilization management activities, including initial reviews ... Director OneNote--to complete timely utilization reviews in Alliance's UM platform and perform ...
Morrisville, NC · Hybrid
$211K - $269K/yr
Ensure the integrity and quality of utilization management activities, including initial reviews ... Director OneNote--to complete timely utilization reviews in Alliance's UM platform and perform ...
Smithfield, NC · Hybrid
$211K - $269K/yr
Ensure the integrity and quality of utilization management activities, including initial reviews ... Director OneNote--to complete timely utilization reviews in Alliance's UM platform and perform ...
Smithfield, NC · Hybrid
$211K - $269K/yr
Ensure the integrity and quality of utilization management activities, including initial reviews ... Director OneNote--to complete timely utilization reviews in Alliance's UM platform and perform ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Raleigh, NC · Remote
This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...
Raleigh, NC · Remote
This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...
Raleigh, NC · On-site
This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...
Raleigh, NC · On-site
This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...
Raleigh, NC · On-site
$15.50 - $20.50/hr
... utilization management regulatory requirements. The Capacity and Transfer Management Center provides direct coordination of internal patient flow and external transfers through comprehensive ...
Raleigh, NC · On-site
$15.50 - $20.50/hr
... utilization management regulatory requirements. The Capacity and Transfer Management Center provides direct coordination of internal patient flow and external transfers through comprehensive ...
Raleigh, NC · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Raleigh, NC · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
$17.5K - $23.3K
1% of jobs
$23.3K - $29.2K
3% of jobs
$29.2K - $35K
11% of jobs
$38.8K is the 25th percentile. Wages below this are outliers.
$35K - $40.8K
16% of jobs
$40.8K - $46.7K
15% of jobs
The median wage is $48.4K / yr.
$46.7K - $52.5K
16% of jobs
$57.3K is the 75th percentile. Wages above this are outliers.
$52.5K - $58.3K
17% of jobs
$58.3K - $64.2K
9% of jobs
$64.2K - $70K
7% of jobs
$70K - $75.8K
3% of jobs
$75.8K - $81.7K
2% of jobs
$17.5K
$50.9K
$81.7K
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
The most popular types of Utilization Management jobs in Raleigh, NC are:
For Director Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:
The top searched job categories for Director Utilization Management jobs in Raleigh, NC are:
Cities near Raleigh, NC with the most Director Utilization Management job openings:
$110 - $150/hr
Other
Posted 8 days ago
