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Manager Utilization Management Jobs in Raleigh, NC

Pharmacy Careers

Appeals Pharmacist (Remote)

Raleigh, NC · On-site +1

$51 - $62.25/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

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All 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 Jul 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 are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

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 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 some common challenges faced by a Manager in 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 does a Manager of 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 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 June 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 77% In-person, and 23% Remote job distribution, with an average salary of $88,470 per year, or $42.5 per hour.
Behavioral Health Case Manager ED 7a-7p

Behavioral Health Case Manager ED 7a-7p

Duke Health

Durham, NC • On-site

Full-time

Posted 18 days ago

Duke Health rating

7.2

Company rating: 7.2 out of 10

Based on 247 frontline employees who took The Breakroom Quiz

328th of 877 rated healthcare providers

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.

About Duke Regional Hospital

Pursue your passion for caring with Duke Regional Hospital in Durham, North Carolina. With 388 beds it is the second largest of Duke Health's four hospitals and offers a comprehensive range ofmedical, surgical, and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services.


DRH-ED 7a-7p Sat-Sun-Mon

Manage a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions across the continuum of care. Ensure optimum utilization of the patient's and the Health System's resources and perform these duties within the requirements of CMS and other external review agencies.

Duties and Responsibilities

  • Monitor daily census and assignment to assure all patients are assessed for case management needs including care coordination/transition and discharge planning, consultations, advocacy, education.
  • Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
  • Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations. Provide education and guidance on these topics to providers, patients and families as needed.
  • 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, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required. Monitor daily census and assignment to assure all patients are assessed for case management needs including care coordination/transition and discharge planning, consultations, advocacy, education.
  • Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
  • Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations. Provide education and guidance on these topics to providers, patients and families as needed.
  • 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, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required.

Inpatient Job Responsibilities/Activities

  • Complete initial assessment within 72 hours to identify psychosocial strengths, weaknesses, community living supports present and needed.
  • Contact with patient primary support systems to gather information regarding dynamics and needs of support system.
  • Conduct support system/family therapy to allow patient/support to practice skills needed to support community living and/or assist in development of functional patterns of interactions.
  • Conduct group sessions for patients focused on skill building/interactional skills.
  • Assist patient in development of safety plan to promote positive coping while living in community setting.
  • Facilitate discharge planning for patients, involving support systems when possible, to provide level of intervention that creates environment for crisis contacts and safe community living.
  • Interface with team to determine multidisciplinary assessment of discharge planning needs and provide information regarding support system/family function.
  • Update Interqual.
  • Other duties as assigned.
  • Typical case load is 10 patients.

Consult/Liason Job Responsibilities/Activities

  • Primary responsibility is to complete assessments in ED and discharge planning for patients within the hospitals.
  • Secondary responsibility is discharge planning assistance for psychiatric followup for patients being treated for a medical condition.
  • Complete crisis assessments to determine level of care required for patient to move to safe community living including but not limited to reason for presentation, current symptoms and level of distress, ability to participate in treatment, safety assessment, past history of treatment, current support systems, strengths, weaknesses and primary psychiatric diagnosis.
  • Facilitate discharge planning with psychiatric appointments or referrals to other facilities as determined by level of care needed.
  • Facilitate tracking of IVC paperwork for all patients who are awaiting transfer to another facility.
  • Interface with team for cases covered by consult service to determine multidisciplinary assessment of discharge planning needs and provide information regarding support system/family function.
  • Update Interqual for patients who are not being treated for a medical condition (typically observation patients at Duke Raleigh).
  • Case load varies as immediate needs vary. As a guide, 3 initial assessments and discharge planning activities for up to 6 patients could be completed during 8 hour shift. Pediatric cases take longer to complete initial assessment so the total number would be reduced if a patient is under 18.
  • Provide community liaison to one mental health workgroup.

Minimum Qualifications

Education

Master's degree in social work from an accredited school of social work.

Experience

3 years of relevant experience.

Degrees, Licensure, and/or Certification

  • Current licensure as a licensed clinical social worker (LCSW) by the NC Social Work Certification and Licensure Board.
  • Consult/Liason should also be a Notary.

Knowledge, Skills, and Abilities

  • Ability to work effectively in a self-directed role
  • Ability to multi-task, capable of daily problem-solving complex issues Excellent written and verbal skills
  • Basic computer skills necessary

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.


Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.


Essential Physical Job Functions:

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.


Employment Type: FULL_TIME

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