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Full Time Optum Health Utilization Review Jobs in Raleigh, NC

Duke University

Utilization Manager

Durham, NC · On-site

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Duke University

Utilization Manager

Durham, NC · On-site

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Elevance Health

Prior Authorization Clinical Pharmacist

Durham, NC · On-site

$114K - $136K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug ... Who We Are Elevance Health is a health company dedicated to improving lives and communities - and ...

Rose Manor Health and Rehab

MDS Coordinator (RN)

Durham, NC · On-site

$33.75 - $40.75/hr

) MDS Coordinator (RN) Full-Time | Exempt | Day Shift We are seeking a clinically strong and highly ... Medicare, and utilization review meetings • Ensure timely completion, validation, and ...

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All JobsOptum Health Utilization Review JobsFull Time Optum Health Utilization Review JobsFull Time Optum Health Utilization Review Jobs in Raleigh, NC

Full Time Optum Health Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do full time optum health utilization review jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for full time optum health 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 Full Time Optum Health Utilization Review vs Full Time Medical Coder?

AspectFull Time Optum Health Utilization ReviewFull Time Medical Coder
CertificationsUtilization Review Certification, CPC or RHIT often preferredCertified Coding Specialist (CCS), CPC
Work EnvironmentHealthcare facilities, insurance companies, remote optionsHospitals, clinics, remote coding roles
Job FocusReviewing medical necessity, authorizations, and insurance claimsTranslating medical records into standardized codes
Industry UsageCommon in health insurance and managed careWidely used in healthcare billing and documentation

While both roles are integral to healthcare operations, Full Time Optum Health Utilization Review focuses on assessing the necessity of care and insurance approvals, whereas Full Time Medical Coder specializes in accurately coding medical records for billing. Understanding these differences helps job seekers identify the right career path in healthcare administration and coding fields.

What are the most commonly searched types of Optum Health Utilization Review jobs in Raleigh, NC?

The most popular types of Optum Health Utilization Review jobs in Raleigh, NC are:

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For Full Time Optum Health Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:

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Full Time Optum Health Utilization Review jobs near you

Case Manager - Utilization Review

Granville Health System

Oxford, NC • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 25 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

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 healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.
About Oxford, NC
Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters-perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.
Position Overview:
The primary role of the Case Manager is to review and monitor members' utilization of health care services with the goal of maintaining high quality, cost-effective care. This role will provide the medical and utilization review expertise necessary to evaluate patient status. This includes reviewing clinical information against established criteria, assessing the medical necessity of services and procedures, collaborating with providers and interdisciplinary teams, and ensuring that the patient is placed at the appropriate level of care from the time of admission. This includes providing referral authorization, concurrent review, proactive discharge/transition planning, appropriate referral to case management, and high-dollar claims review.
Position Highlights:
  • Retirement Benefits: NC Local Government Pension Plan (5-year vesting period)
  • Loan Forgiveness: Eligible employer for Public Service Loan Forgiveness (PSLF)
  • Comprehensive Benefits: Medical, dental, vision, life insurance, and various supplemental benefits available

Key Responsibilities:
• Conduct concurrent review of all patients, regardless of payer source, using approved screening criteria
• Perform admission reviews on the first working day following admission
• Conduct continued stay reviews at least every three (3) days or more frequently as indicated
Qualifications
Associate degree in a healthcare-related field or equivalent combination of healthcare experience and education.
At least a year of experience in a related role (utilization review, case management, care coordination, insurance authorization/prior authorization, clinical documentation review, hospital patient access or revenue cycle support, healthcare quality or compliance functions).
Strong attention to detail, organizational skills and interpersonal skills. Ability to interpret clinical documentation and apply review criteria. Strong communication skills for interaction with physicians and interdisciplinary teams. Knowledge of healthcare regulations and payer requirements
Preferred
Bachelor's degree in Health Administration, Public Health, Social Work, Healthcare Management, or related field. Accredited Case Manager (ACM) certification.
Experience with insurance authorization criteria preferred; one year utilization and discharge planning experience.
Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.

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