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Full Time Optum Health Utilization Review Jobs in Raleigh, NC

Senture

Medical Director

Raleigh, NC · On-site

... health plan, or utilization management operation The Medical Director works collaboratively with organizational leadership, credentialing staff, peer reviewers, and regulatory stakeholders to ensure ...

Senture

Medical Director

Raleigh, NC · Remote

... health plan, or utilization management operation The Medical Director works collaboratively with ... Minimum three (3) years of experience supporting policy interpretation, utilization review ...

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Work with the business office and the utilization review department to ensure payment for services ... Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... case management and utilization review encouraged C. Licensure/Certification 1. Current ... Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... case management and utilization review encouraged C. Licensure/Certification 1. Current ... Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... case management and utilization review encouraged C. Licensure/Certification 1. Current ... Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs ...

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC

... healthcare. The Lead Registered Nurse (Lead RN) provides clinical leadership and oversight of ... Participates in quality improvement, utilization review, infection control, and risk management ...

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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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Full Time Optum Health Utilization Review jobs near you

Medical Director - Public Health (Tiered Sign-On Bonus up to $5,000)

Wake County Government

Raleigh, NC

Full-time

Posted 16 days ago

Wake County rating

8.5

Company rating: 8.5 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

218th of 845 rated public administrative organizations

Job description

As the Medical Director for Wake County Public Health, you will be a key leader shaping the health and wellbeing of our community. In this role, you guide the clinical vision of the department and ensure our services align with the goals of Wake County, the Health Director, the Board of Commissioners, and state and federal mandates.

You will set the standard for medical excellence across Public Health, developing, implementing, and evaluating medical policies and clinical practice guidelines that strengthen care delivery. You'll serve as the primary physician for public health clinical services, providing medical orders, consultation, and direction to multidisciplinary teams. As a trusted partner to the broader medical community, you will build collaborative relationships that support population health goals and expand access to highquality care throughout Wake County.

You will also play a critical leadership role during urgent and emergent public health events, from communicable disease outbreaks to disaster response, helping guide clinical strategy and coordination during times when the community needs it most.

As a member of the Public Health Leadership Team, you will represent the department publicly through media interviews, community presentations, and participation on committees and workgroups, helping communicate important public health issues, priorities, and initiatives.

Essential Functions of the Medical Director include: 

Administration & Leadership

  • Serves as senior medical administrator supporting Public Health Director in advancing mission, culture, and strategic priorities.
  • Oversees all medical services across Public Health, ensuring integration and alignment across clinics, disciplines, and operational units.
  • Develops and enforces clinical policies, procedures, standing orders, and provider performance standards.
  • Provides oversight for physician/APRN recruitment, credentialing, supervision, and quality of clinical practice.
  • Supervises Provider Supervisors and provides medical oversight to clinical, laboratory, and pharmacy staff.
  • Conducts leadership rounding to assess team needs, support staff well-being, and improve workflows and patient experience.
  • Performs limited direct patient care as mutually agreed upon with department leadership.

Quality, Compliance & Risk Management

  • Ensures clinical operations consistently meet regulatory, legal, and ethical standards.
  • Leads evaluation of public health programs, quality assurance, utilization review, and costeffective service delivery.
  • Chairs the Human Subjects Review Panel, ensuring ethical research practices.
  • Collaborates with Occupational Health/ Infection Control Nurse to advise on compliance and safety matters.

Occupational Health, Safety & Infection Control

  • Provides oversight and guidance for employee health surveillance and occupational health program development.
  • Supports creation, implementation, and review of occupational health policies and infection control procedures.
  • Advises Health Director on emerging occupational health needs and compliance issues.

What Wake County employees say

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