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Director Utilization Management Jobs in Raleigh, NC

Aprio

Senior Director, Resource Management

Raleigh, NC · On-site +1

$225K - $300K/yr

Aprio is a progressive, fast-growing firm looking for a Senior Director, Resource Management to ... Analyze trends in utilization, availability, backlog, pipeline, and seasonal demand to drive timely ...

Hire Talent

Licensed Practical Nurse (LPN)

Durham, NC

$23.25 - $31.75/hr

... § Utilization management tasks for the center Required Qualifications o Current LPN license. o Minimum 2 years of direct clinical experience (e.g., triage, EKGs, phlebotomy, medication ...

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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 Jun 13, 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 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 is a Director Utilization Management job?

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 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 June 2026, with employment types broken down into 1% As Needed, 84% Full Time, and 15% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $50,861 per year, or $24.5 per hour.
Medical Economics Analyst (Full-time Remote, NC Based)

Medical Economics Analyst (Full-time Remote, NC Based)

Alliance Health

Morrisville, NC • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

The Medical Economics Analyst performs detailed statistical analysis related to the organization’s service delivery.  The Analyst will create and manage reports that monitor care utilization, premium, and MLR.  The Analyst will support the Director of Medical Economics in identifying potential cost of care initiatives and will work closely with other areas of the business to monitor their efficacy.

This position is full-time remote. Selected candidate must reside in North Carolina and be willing to travel to the home office (Morrisville, NC) for onsite team meetings as needed.

Responsibilities & Duties

Care Utilization Analysis

  • Analyze and monitor care utilization through the lens of Medical Economics Metrics.  Including but not limited to: PMPM, Utilization per thousand, prevalence and intensity
  • Develop and maintain reports related to Care Utilization, Premium and Pay for Performance plans
  • Monitor monthly utilization patterns and create utilization forecasts
  • Identify cost drivers and work with the Director of Medical Economics to develop action plans
  • Develop and maintain ad hoc care utilization reporting tools for business stakeholders

Financial Forecasting

  • Create and maintain financial models to assess the impact of Medical Cost Action Plans
  • Assess the financial impact of rate and policy changes made by the State of North Carolina to the Medicaid Tailored Plans

Reporting and Data Visualization

  • Utilize SQL, Excel and MicroStrategy to develop and maintain dashboards, reports, and other data visualizations for various business stakeholders

Research and Collaboration

  • Stay up to date on industry trends, regulations and healthcare policies that may impact Alliance’s financial performance
  • Collaborate with cross-functional teams, including Utilization Management and Provider Network, to develop data-driven recommendations and actionable strategies

Minimum Requirements

Education & Experience

Bachelor’s Degree in Healthcare Management, Health Informatics, Economics, Statistics, Finance, or a related field and at least three (3) years of experience in finance or analytics. 

Knowledge, Skills, & Abilities

  • Thorough knowledge of financial data analysis and methodology, preferably with experience in a healthcare field
  • Strong Microsoft Office skills
  • Expert proficiency in Excel and SQL
  • Strong Business Acumen
  • Strong analytical and quantitative skills
  • Problem solving skills
  • Strong written and verbal communication skills for a diverse work group, and an ability to present complex data to non-technical stakeholders
  • Ability to work independently   
  • Ability to develop strong working relationships with divergent groups and communicate technical concepts to lay persons
  • Ability to solicit cooperation from persons and departments throughout the organization
  • Ability to resolve complex problems that require the evaluation of alternative methods and solutions;
  • Ability to set objectives and prioritize workflow
  • Ability to make prompt decisions on complex matters and make evaluations concerning day to day operations
  • Ability to prepared concise and accurate reports and plans.

Employment for this position is contingent upon a satisfactory background and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date. 

Salary Range 

$60,2341-$76,799/Annually 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity. 

An excellent fringe benefit package accompanies the salary, which includes:  

  • Medical, Dental, Vision, Life, Long Term Disability
  • Generous retirement savings plan
  • Flexible work schedules including hybrid/remote options
  • Paid time off including vacation, sick leave, holiday, management leave
  • Dress flexibility

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