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Home Based Utilization Review Nurse Jobs in Raleigh, NC

Duke Health

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Utilizes an evidenced-based clinical review screening criteria as a guide to support medical ...

Duke University

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Utilizes an evidenced-based clinical review screening criteria as a guide to support medical ...

Duke Health

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Utilizes an evidenced-based clinical review screening criteria as a guide to support medical ...

Duke University

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Utilizes an evidenced-based clinical review screening criteria as a guide to support medical ...

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Home Based Utilization Review Nurse information

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$41

$67

How much do home based utilization review nurse jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for home based 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 a home based utilization review nurse?

Home Based Utilization Review Nurses are registered nurses who work remotely, typically from their homes, to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records, coordinate with healthcare providers, and ensure that patient care meets established guidelines and insurance requirements. These nurses play a crucial role in managing healthcare costs and improving patient outcomes by ensuring that patients receive the right level of care. They often interact with insurance companies, healthcare facilities, and patients to facilitate approvals and appeals for medical services.

How does a home based utilization review nurse typically collaborate with physicians and care teams while working remotely?

As a Home Based Utilization Review Nurse, collaboration with physicians and interdisciplinary care teams is primarily conducted through secure digital platforms, phone calls, and video meetings. You will review patient records, discuss care plans, and provide recommendations to ensure appropriate resource utilization. Effective communication skills are essential, as you'll need to clearly convey clinical findings and advocate for necessary services while balancing payer guidelines. Building strong virtual relationships and staying organized with documentation are key to overcoming the challenges of remote teamwork.

What are the key skills and qualifications needed to thrive as a home based utilization review nurse, and why are they important?

To thrive as a Home Based Utilization Review Nurse, you need a valid RN license, clinical experience, and a strong understanding of medical necessity criteria and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards such as Medicare or Medicaid are typically required. Critical thinking, attention to detail, and effective communication are standout soft skills for this role. These skills ensure accurate case assessments, compliance with policies, and effective collaboration, which are vital for optimizing patient outcomes and healthcare resource utilization.

What is the difference between Home Based Utilization Review Nurse vs Telehealth Nurse?

AspectHome Based Utilization Review NurseTelehealth Nurse
CredentialsRN license, possibly certifications in case management or utilization reviewRN license, may have certifications in telehealth or specialty areas
Work EnvironmentHome office, reviewing patient cases remotely for insurance or healthcare providersRemote or clinical setting providing patient care via telecommunication tools
Employer & IndustryInsurance companies, healthcare organizations, utilization review firmsHospitals, clinics, telehealth companies, healthcare providers

The Home Based Utilization Review Nurse primarily focuses on reviewing patient cases remotely to determine appropriate care and resource utilization, often for insurance purposes. In contrast, the Telehealth Nurse provides direct patient care via telecommunication platforms, offering advice, education, and clinical support. While both roles are remote and require nursing credentials, their core responsibilities and work environments differ significantly.

How to get into home based utilization review nurse?

To become a home-based utilization review nurse, candidates typically need a registered nurse (RN) license, experience in case management or utilization review, and knowledge of healthcare policies. Certification such as the Certified Professional in Healthcare Quality (CPHQ) can enhance job prospects, and strong communication skills are essential for remote work environments.

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 Home Based Utilization Review Nurse jobs in Raleigh, NC?

For Home Based Utilization Review Nurse jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Home Based Utilization Review Nurse jobs in Raleigh, NC look for?

The top searched job categories for Home Based Utilization Review Nurse jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Home Based Utilization Review Nurse jobs?

Cities near Raleigh, NC with the most Home Based Utilization Review Nurse job openings:

Home Based Utilization Review Nurse jobs near you
Infographic showing various Home Based Utilization Review Nurse job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, and 5% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Per diem

Re-posted 14 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

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

Pay

Hours and flexibility

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