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Full Time Optum Utilization Review Jobs in Raleigh, NC

Case Manager SE

Wake Forest, NC ยท On-site

$38.20 - $57.30/hr

Care Coordination Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details ... case management and utilization review encouraged C. Licensure/Certification 1. Current ...

Case Manager SE

Wake Forest, NC ยท On-site

$38.20 - $57.30/hr

Care Coordination Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details ... case management and utilization review encouraged C. Licensure/Certification 1. Current ...

Case Manager SE

Wake Forest, NC ยท On-site

$38.20 - $57.30/hr

Care Coordination Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details ... case management and utilization review encouraged C. Licensure/Certification 1. Current ...

Warehouse Supervisor - Full Time

Durham, NC ยท On-site

$80K - $120K/yr

... asset utilization and preparing reviewing andor analyzing business reports Respect the Individual ... full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high ...

Registered Nurse - RN

Durham, NC ยท On-site

$45.71 - $68.56/hr

As members of the Optum family of businesses, we are dedicated to helping people feel their best ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

... asset utilization and preparing reviewing andor analyzing business reports Respect the Individual ... full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high ...

Warehouse Supervisor - Full Time

Carrboro, NC ยท On-site

$80K - $120K/yr

... asset utilization and preparing reviewing andor analyzing business reports Respect the Individual ... full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high ...

... asset utilization and preparing reviewing andor analyzing business reports Respect the Individual ... full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high ...

Showing results 21-40

Full Time Optum Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Aug 9, 2026, the average hourly pay for full time optum 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 are some common challenges faced by full time Optum utilization review, and how can they be managed?

Full Time Optum Utilization Review nurses often encounter challenges such as managing high caseloads, staying updated with frequently changing insurance and regulatory guidelines, and effectively communicating with both healthcare providers and patients. Time management and strong organizational skills are crucial for balancing documentation with timely case reviews. Collaborating closely with multidisciplinary teams and utilizing technology tools provided by Optum can help streamline workflows and ensure compliance with policies, ultimately leading to more effective patient care coordination.

What are the key skills and qualifications needed to thrive as a full time Optum utilization review?

To thrive as a Full Time Optum Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and platforms like InterQual or MCG is typically required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively coordinating care and collaborating with providers. These abilities ensure efficient, compliant care management, cost containment, and optimal patient outcomes within the healthcare system.

What is a full time Optum utilization review?

A Full Time Optum Utilization Review position involves working for Optum, a healthcare services company, to review patient medical records and determine the medical necessity and appropriateness of healthcare services. Utilization Review professionals collaborate with healthcare providers, insurers, and patients to ensure that care provided is efficient, cost-effective, and aligns with established guidelines. The role typically requires knowledge of clinical standards, strong communication skills, and the ability to interpret medical documentation. Full-time positions often come with benefits and require standard weekly work hours.

What is the difference between Full Time Optum Utilization Review vs Full Time Medical Reviewer?

AspectFull Time Optum Utilization ReviewFull Time Medical Reviewer
CertificationsTypically requires medical licenses and utilization review certificationsRequires medical licenses, often with additional certifications in utilization review
Work EnvironmentInsurance companies, healthcare organizations, remote or office-basedHospitals, clinics, insurance companies, often in clinical settings
Employer & Industry UsagePrimarily in health insurance and managed careIn healthcare facilities and insurance sectors

Full Time Optum Utilization Review professionals focus on evaluating medical necessity for insurance claims, often working remotely or in insurance settings. Full Time Medical Reviewers also assess medical necessity but may work directly within clinical environments. Both roles require medical credentials and involve reviewing patient records, but their work settings and employer types differ slightly.

What are the most commonly searched types of Optum Utilization Review jobs in Raleigh, NC? The most popular types of Optum Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Full Time Optum Utilization Review jobs? Cities near Raleigh, NC with the most Full Time Optum Utilization Review job openings:

Nursing Coordinator VAD - VAD Program

UNC HEALTH

Chapel Hill, NC โ€ข On-site

$38.55 - $55.43/hr

Full-time

Re-posted 2 days ago


Job description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.
Summary:
The VAD (Ventricular Assist Device) Nurse Coordinator coordinates the VAD care of all pediatric and adult VAD patients. The VAD Coordinator provides follow-up and care across the continuum from pre-VAD, during VAD implant admission and post VAD. S/he collaborates with members of the health care team to enhance patient care by developing, supporting and educating nursing staff. S/he is a clinician, educator, investigator, consultant and leader. S/he makes clinical judgments based upon a synthesis of current research, concepts, principles, theories, and outcomes to solve complex problems. The VAD Nurse Coordinator is an integral member of a larger multi-disciplinary team contributing to excellence in
patient care, research, teaching, and in providing leadership to the organization.
Responsibilities:
Collaborates with the VAD program administrator in short, intermediate, and long range planning for the VAD program through regularly scheduled staff and individual program meetings
Continuous Quality Improvement. Participates in the development, implementation and evaluation of the VAD program's CQI efforts that focus on maximizing the outcomes for patient survival and quality of life. Reviews patient resource utilization with administrative and clinical staff to identify areas for improvement. Participates in the development and improvement of clinical pathways.
Education. Educates patients and their families about the VAD process and what to expect during each phase of care (pre, peri, and post). Responsible for planning and acquiring or designing educational materials, and presenting educational programs to patients and staff, other professionals, the community and outside agencies.
Patient Care- Oversees and/or coordinates the clinical, psychosocial and financial needs of the VAD patient. Coordinates evaluation tests and consults to determine VAD candidacy and facilitates VAD by organizing patient and VAD team. Monitors inpatient status, discharge needs and follow-up care per program standards
Regulatory Compliance. Documents and maintains patient VAD information in the electronic medical record with current data and required information to ensure regulatory compliance.
Other Information
Other information:
Education Requirements:
โ€ข Bachelor's degree in Nursing (BSN) from a state-accredited school of professional nursing.
Licensure/Certification Requirements:
โ€ข Licensed to practice as a Registered Nurse in the state of North Carolina.
Professional Experience Requirements:
โ€ข Three (3) years of professional nursing experience to include two (2) years in VAD or transplant, critical care, disease specific area.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: STATE
Entity: UNC Medical Center
Organization Unit: Lung Pre-Transplant
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $38.55 - $55.43 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: Yes
This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.