Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality health ...
Case Manager - Utilization Review Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been at the forefront of quality 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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
... N Experience in the public Intellectual and Developmental Disability (I/DD)/TBI field is highly desired due to the complexity of the work Experience in a Utilization Review and/or Utilization ...
Posted today
... N Experience in the public Intellectual and Developmental Disability (I/DD)/TBI field is highly desired due to the complexity of the work Experience in a Utilization Review and/or Utilization ...
Posted today
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...
Quick apply
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...
MDS Coordinator (RN)
Durham, NC · On-site
$33.75 - $40.75/hr
... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...
RN Care Manager - (Per Diem) Care Management
Smithfield, NC · On-site
$35.87 - $51.57/hr
... utilization review and discharge planning. The Care Manager must be highly organized professional with great attention to detail, adaptable to frequent change, and compliant with regulatory and ...
RN Care Manager - (Per Diem) Care Management
Smithfield, NC · On-site
$35.87 - $51.57/hr
... utilization review and discharge planning. The Care Manager must be highly organized professional with great attention to detail, adaptable to frequent change, and compliant with regulatory and ...
RN Pediatric Clinical Educator
$80K - $83K/yr
Current RN license in good standing * BSN/MSN preferred * Minimum two years of staff development or ... chart review, and utilization review reporting * Strong assessment and organizational skills
Quick apply
RN Pediatric Clinical Educator
$80K - $83K/yr
Current RN license in good standing * BSN/MSN preferred * Minimum two years of staff development or ... chart review, and utilization review reporting * Strong assessment and organizational skills
Entry Level Utilization Review Nurse information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do entry level utilization review nurse jobs pay per hour?
As of Jul 31, 2026, the average hourly pay for entry level 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 are some common challenges faced by entry level Utilization Review Nurses, and how can they overcome them?
Entry level Utilization Review Nurses often encounter challenges such as adapting to complex insurance policies, learning to review medical records efficiently, and communicating effectively with physicians and case managers. To overcome these challenges, new nurses should seek mentorship from experienced colleagues, participate in ongoing training sessions, and familiarize themselves with the organization's review protocols and documentation systems. Building strong communication skills and staying up to date with regulatory changes will also help in navigating the learning curve and ensuring successful case reviews.
What is the difference between Entry Level Utilization Review Nurse vs Utilization Review Nurse?
| Aspect | Entry Level Utilization Review Nurse | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, possibly some certification | RN license, often with additional certifications |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Insurance companies, healthcare organizations |
| Job Responsibilities | Assist in reviewing patient cases, gather data, support senior staff | Evaluate medical necessity, review patient records, make coverage decisions |
The Entry Level Utilization Review Nurse typically supports the more experienced Utilization Review Nurse by gathering information and assisting in case reviews. Both roles require an RN license and work within healthcare or insurance settings, but the entry-level position involves more support tasks, while the Utilization Review Nurse makes critical coverage decisions.
How to make $300,000 as a nurse?
An entry level utilization review nurse can increase earning potential by gaining specialized certifications, such as Certified Case Manager (CCM), and accumulating experience in high-demand settings. Advancing to senior or managerial roles, working overtime, or obtaining additional qualifications can also help reach higher salary levels, though earning $300,000 typically requires significant experience and specialization beyond entry level.
How to get into utilization review as a nurse?
To become an entry-level utilization review nurse, candidates typically need a registered nurse (RN) license and relevant clinical experience. Gaining knowledge of insurance processes, medical coding, and utilization review guidelines, along with completing any required certifications such as Certified Professional in Healthcare Quality (CPHQ), can improve job prospects.
What are the key skills and qualifications needed to thrive as an Entry Level Utilization Review Nurse, and why are they important?
To thrive as an Entry Level Utilization Review Nurse, you need a registered nurse (RN) license, knowledge of clinical guidelines, and an understanding of healthcare regulations. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are often beneficial. Strong analytical thinking, attention to detail, and effective communication skills help you review cases accurately and collaborate with providers. These skills ensure appropriate care decisions, compliance with payer requirements, and optimal patient outcomes.
Is it hard to be a utilization review nurse?
Being an entry-level utilization review nurse involves reviewing medical records and determining coverage eligibility, which requires attention to detail, strong communication skills, and knowledge of healthcare policies. The role can be demanding due to the need for accuracy and adherence to regulations, but it often offers a structured environment with standard work hours. Certification in case management or utilization review can enhance job prospects and effectiveness.
What is an Entry Level Utilization Review Nurse?
An Entry Level Utilization Review Nurse is a registered nurse (RN) who is new to the field of utilization review. Their main responsibilities include assessing medical records, ensuring that patients receive appropriate and necessary care, and verifying that health services are delivered according to established guidelines and insurance requirements. They typically work for hospitals, insurance companies, or managed care organizations and collaborate with healthcare providers to support quality patient outcomes while managing costs. This role often serves as a stepping stone to more advanced positions in healthcare administration or case management.
How to make an extra 2000 a month as a nurse?
An entry level utilization review nurse can increase income by taking on additional part-time or freelance review assignments, obtaining relevant certifications like the Certified Professional Coder (CPC), or working overtime if available. Developing specialized skills in medical coding, documentation, or telehealth can also open opportunities for higher-paying side work or contract roles.
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 Entry Level Utilization Review Nurse jobs in Raleigh, NC? For Entry Level Utilization Review Nurse jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Entry Level Utilization Review Nurse jobs in Raleigh, NC look for? The top searched job categories for Entry Level Utilization Review Nurse jobs in Raleigh, NC are:
- Nurse Practitioner Utilization Review
- Remote Occupational Therapy Utilization Review
- Full Time Kaiser Rn
- Remote Rn Utilization Review Nurse
- Pediatric Utilization Review
- Remote Preservice Review Nurse
- Remote Aetna Utilization Review Nurse
- Registered Nurse Case Review
- Registered Nurse Risk Manager
- From Home Tricare Rn
What cities near Raleigh, NC are hiring for Entry Level Utilization Review Nurse jobs? Cities near Raleigh, NC with the most Entry Level Utilization Review Nurse job openings:
Granville Health System rating
8.6
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
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Hours and flexibility
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