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Director Utilization Management Jobs in Raleigh, NC

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance ... Ability to work effectively in a self-directed role * Ability to multi-task * LCSW-A or LCSW * ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance ... Ability to work effectively in a self-directed role * Ability to multi-task * LCSW-A or LCSW * ...

HonorBridge

Director of Referral Management

Raleigh, NC · On-site

... Director, Referral Optimization provides strategic leadership for HonorBridge's referral management ... allocation and utilization, and build strong partnerships with hospitals and other healthcare ...

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Showing results 21-40

All JobsUtilization Management JobsDirector Utilization Management JobsDirector Utilization Management Jobs in Raleigh, NC

Director Utilization Management information

See Raleigh, NC salary details

$17.5K

$50.9K

$81.7K

How much do director utilization management jobs pay per year?

As of Sep 3, 2026, the average yearly pay for director utilization management in Raleigh, NC is $50,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $38,900.00 and $58,300.00 per year, depending on experience, location, and employer.

What is a director utilization management?

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.

What are the typical daily responsibilities of a director utilization management?

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.

What are the key skills and qualifications needed to thrive in the director utilization management position, and why are they important?

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.

What does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are medically necessary and cost-effective. They develop policies, manage teams of reviewers, and collaborate with healthcare providers and insurance companies to optimize patient care and resource utilization.

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

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

What are popular job titles related to Director Utilization Management jobs in Raleigh, NC?

For Director Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Director Utilization Management jobs in Raleigh, NC look for?

The top searched job categories for Director Utilization Management jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Director Utilization Management jobs?

Cities near Raleigh, NC with the most Director Utilization Management job openings:

Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $50,861 per year, or $24.5 per hour.

Director, Specialty Pharmacy and Payer Accounts

Scorpion Therapeutics

Durham, NC • On-site

$150 - $190/hr

Other

Posted 4 days ago

Job description

Responsibilities:
  • Own payer (health plan) commercial account relationships; engage pharmacy/medical leadership on formulary tier positioning, prior authorization, step therapy, and coverage policy.
  • Monitor/respond to health plan coverage decisions (formulary, utilization management, clinical policy) and coordinate rapid responses.
  • Drive specialty pharmacy (SP) pull-through performance: manage account relationships and performance scorecards (time-to-fill, dispense rates, hub handoff quality, patient persistence, REMS compliance) across SP partners.
  • Translate payer access outcomes into SP pull-through priorities; connect SP performance gaps back to upstream payer access barriers.
  • Coordinate enterprise messaging alignment.
  • Lead regular business reviews; present portfolio performance data and align on pull-through initiatives.
  • Build/maintain segment-level dashboards (formulary access status, SP dispense performance, co-pay utilization, patient access metrics).
  • Identify/escalate access failures (PA denials, step therapy barriers, SP dispensing gaps) with root cause analysis and recommended responses.
Qualifications:
  • Required: Bachelor’s degree; 10+ years pharmaceutical commercial experience; 4+ years payer access managed care account management or specialty pharmacy channel management; experience managing health plan/managed care accounts; experience managing specialty pharmacy accounts and driving SP pull-through against scorecards.
  • Preferred: MBA/advanced degree; Director-level managed care/specialty experience at pharma/biotech; ability to link payer strategy to SP execution; strong cross-functional/enterprise track record; strong analytical skills; oncology/specialty experience; familiarity with REMS, LDD products, and specialty benefit channel mechanics.
Skills:
  • Account management
  • Cross-functional work
  • Data to insights
  • Digital fluency
  • Omnichannel
  • Scientific literacy
Application:

Submit resume and a brief note describing a payer or specialty pharmacy negotiation you led and the impact delivered.

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