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Manager Utilization Management Jobs in Raleigh, NC

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. * Maintain timely documentation of assessment findings ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. * Maintain timely documentation of assessment findings ...

WakeMed

Patient Flow Coordinator, RN

Raleigh, NC · On-site

$15.50 - $20.50/hr

The Patient Flow Coordinator will also ensure compliance with federal, state, and third-party utilization management regulatory requirements. The Capacity and Transfer Management Center provides ...

New

The Emily Program

Admissions Manager

Durham, NC · On-site

$80K - $90K/yr

This role partners closely with other leaders across the organization including clinical, operational, and utilization management teams. Success in this role requires strong leadership, operational ...

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Showing results 21-40

All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Raleigh, NC

Manager Utilization Management information

See Raleigh, NC salary details

$37.9K

$88.5K

$162.8K

How much do manager utilization management jobs pay per year?

As of Sep 5, 2026, the average yearly pay for manager utilization management in Raleigh, NC is $88,470.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,800.00 and $106,400.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Raleigh, NC?

The most popular types of Utilization Management jobs in Raleigh, NC are:

What are popular job titles related to Manager Utilization Management jobs in Raleigh, NC?

For Manager Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Raleigh, NC look for?

The top searched job categories for Manager Utilization Management jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Manager Utilization Management jobs?

Cities near Raleigh, NC with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Raleigh, NC as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,470 per year, or $42.5 per hour.

Sr Clinical Pharmacist

Habitat For Humanity Of Durham

Durham, NC • On-site

$119 - $190/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Key responsibilities

  • Serve as the strategic clinical pharmacy lead and primary advisor for pharmacy benefit strategies for a large employer client.

  • Develop, communicate, and support the execution of pharmacy benefit strategies related to formulary design, utilization management, clinical programs, and emerging drug trends.

  • Partner with internal teams and client stakeholders to ensure successful delivery of pharmacy benefit programs and achievement of client objectives.

Job description

Job Description

We are hiring for a Senior Clinical Pharmacist! This individual will serve as the strategic clinical pharmacy lead and primary pharmacy advisor for a large employer client. You will be responsible for developing, communicating, and executing pharmacy benefit strategies that optimize clinical outcomes, member experience, and total cost of care. You will also acts as the primary clinical liaison between Blue Cross NC and client stakeholders, providing leadership across formulary management, utilization management, clinical programs, rebate strategy, and pharmacy operations. Also, this individual will partner closely with internal pharmacy, medical, finance, analytics, operations, and account management teams to ensure successful delivery of pharmacy benefit solutions and achievement of client objectives.

What You’ll Do
  • Serve as the strategic clinical pharmacy lead and trusted advisor for a large employer client, providing consultation and recommendations on pharmacy benefit strategy and performance.
  • Develop and communicate pharmacy benefit strategies related to formulary design, utilization management, specialty pharmacy, clinical programs, and emerging drug trends.
  • Collaborate with client leadership and internal stakeholders to align pharmacy strategies with business objectives, affordability goals, and member health outcomes.
  • Lead and support client-facing meetings, quarterly business reviews, strategic planning sessions, and executive presentations.
  • Evaluate pharmacy trend drivers, utilization patterns, pipeline therapies, and market developments to identify opportunities for program optimization.
  • Provide clinical leadership and oversight for formulary management initiatives, utilization management programs, and evidence-based coverage strategies.
  • Partner with rebate and financial teams to evaluate manufacturer contracting opportunities and rebate strategies that support client objectives.
  • Support the development, implementation, and monitoring of clinical programs including specialty pharmacy management, site-of-care optimization, preventive medication strategies, and drug utilization initiatives.
  • Collaborate with pharmacy operations teams to ensure successful implementation and ongoing management of pharmacy benefit programs.
  • Analyze and present clinical and financial performance metrics, identifying emerging risks, opportunities, and recommended actions.
  • Ensure compliance with applicable regulatory, accreditation, and quality requirements related to pharmacy benefits.
  • Serve as a subject matter expert for internal business partners, sales teams, account management teams, and executive leadership.
  • Maintain awareness of industry trends, emerging therapies, regulatory developments, and innovative pharmacy benefit solutions.
What You Bring
  • Doctor of Pharmacy (PharmD) degree
  • In lieu of degree, 10+ years of experience in related field.
  • Active pharmacist license in North Carolina or ability to obtain licensure prior to hire.
Bonus Points(Preferred Qualifications)
  • 5+ years of managed care, health plan, PBM, or employer pharmacy consulting experience.
  • Experience serving as a dedicated clinical lead for a large employer, government, or public-sector client.
  • Proven experience leading complex pharmacy initiatives involving multiple stakeholders and cross-functional teams.
  • Demonstrated experience presenting and consulting with executive-level clients and external stakeholders.
  • Strong experience with formulary management, utilization management strategy, pharmacy trend management, and clinical program development.
  • Experience with rebate strategy, manufacturer contracting concepts, and pharmacy financial management preferred.
  • Working knowledge of pharmacy operations, specialty pharmacy, and pharmacy benefit administration preferred.
  • Excellent communication, relationship management, presentation, and influencing skills.
  • Strong preference for candidates residing in or willing to relocate to the Raleigh-Durham area to support ongoing client engagement and partnership activities.
What You’ll Get
  • The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
  • Work-life balance, flexibility, and the autonomy to do great work
  • Medical, dental, and vision coverage along with numerous health and wellness programs
  • Parental leave and support plus adoption and surrogacy assistance
  • Career development programs and tuition reimbursement for continued education
  • 401k match including an annual company contribution
  • Learn more
Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$118,691.00 - $189,906.00

Skills

Clinical Knowledge, Clinical Pharmacy, Clinical Practice Management, Clinical Programs, Clinical Review, Clinical Trials Operations, Medicare, Medicare Part D, Medication Therapy Management, Nursing Practice, Patient Care Coordination, Pharmaceutical Medical Affairs, Pharmacy, Pharmacy Compliance, Pharmacy Management, Pharmacy Operations

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