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Full Time Remote Utilization Review Nurse Jobs in Raleigh, NC

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Full Time Remote Utilization Review Nurse information

See Raleigh, NC salary details

$20

$41

$67

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

As of Sep 1, 2026, the average hourly pay for full time remote 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 is the difference between Full Time Remote Utilization Review Nurse vs Part Time Remote Utilization Review Nurse?

AspectFull Time Remote Utilization Review NursePart Time Remote Utilization Review Nurse
Work HoursTypically 40 hours/weekLess than 20 hours/week
CertificationsRN license, utilization review certification often preferredRN license, utilization review certification often preferred
Work EnvironmentRemote, independent review settingRemote, independent review setting
Employer UsageHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations

Full Time Remote Utilization Review Nurses work standard hours and provide comprehensive review services, while Part Time roles offer flexibility with fewer hours. Both roles require similar credentials and are employed in remote healthcare settings by hospitals and insurance companies.

What are popular job titles related to Full Time Remote Utilization Review Nurse jobs in Raleigh, NC?

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

What job categories do people searching Full Time Remote Utilization Review Nurse jobs in Raleigh, NC look for?

The top searched job categories for Full Time Remote Utilization Review Nurse jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Full Time Remote Utilization Review Nurse jobs?

Cities near Raleigh, NC with the most Full Time Remote Utilization Review Nurse job openings:

Full Time Remote Utilization Review Nurse jobs near you

Utilization Management Nurse

Chapel Hill, NC • Remote

Brighton Health Plan Solutions, LLC
201 - 500 employees
Learn more about Brighton Health Plan Solutions, LLCexternal

Full-time

Re-posted 25 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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