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Nurse Practitioner Utilization Review Jobs in Raleigh, NC

Gentiva Hospice

Nurse Practitioner

Henderson, NC · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Gentiva Hospice

Nurse Practitioner

Clayton, NC · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Gentiva Hospice

Nurse Practitioner

Clayton, NC · On-site

... care utilization. * Prescribe medications and treatments, including controlled substances, as ... Communicate findings, treatment plans, diagnostics, and medication reviews with IDG/IDT. * Provide ...

Duke University

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke University

Utilization Manager

Durham, NC · On-site

Nurses from each hospital are consistently recognized each year as North Carolina's Great 100 ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

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Nurse Practitioner Utilization Review information

See Raleigh, NC salary details

$69K

$130.6K

$204.6K

How much do nurse practitioner utilization review jobs pay per year?

As of Aug 11, 2026, the average yearly pay for nurse practitioner utilization review in Raleigh, NC is $130,618.00, according to ZipRecruiter salary data. Most workers in this role earn between $107,900.00 and $148,200.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the nurse practitioner utilization review position, and why are they important?

To thrive as a Nurse Practitioner Utilization Review, you need advanced clinical knowledge, current NP licensure, and expertise in reviewing medical records for appropriateness of care. Familiarity with utilization management software, ICD-10/CPT coding, and case management systems is typically required, along with relevant certifications such as URAC or CCM. Strong analytical thinking, attention to detail, effective written communication, and collaboration skills help you excel in evaluating care plans and working with multi-disciplinary teams. These abilities ensure accurate assessment of healthcare services, optimal resource use, and regulatory compliance within healthcare organizations.

What are common day-to-day responsibilities for a nurse practitioner utilization review?

A Nurse Practitioner Utilization Review typically spends their day evaluating patient records, determining medical necessity of treatments, and ensuring care meets established guidelines and payer requirements. This role involves frequent collaboration with physicians, case managers, and insurance representatives to clarify or appeal decisions as needed. You may also participate in team meetings, develop recommendations for optimizing utilization, and provide education to clinical staff regarding documentation or policy changes. The work is often remote or office-based, with a predictable schedule and minimal direct patient contact. This structure allows for a balanced workload and a focus on analytical aspects of patient care.

What is a nurse practitioner utilization review?

A Nurse Practitioner Utilization Review (NP UR) job involves evaluating medical records to ensure treatments are medically necessary, cost-effective, and compliant with healthcare guidelines. NP UR professionals work with insurance companies, healthcare organizations, or government agencies to review patient care decisions, approve or deny claims, and recommend alternative treatments when needed. They use clinical expertise to assess whether services align with best practices and healthcare policies. This role is typically non-clinical, involving case reviews, documentation, and collaboration with healthcare providers. It helps improve patient care efficiency while controlling costs.

What are the most commonly searched types of Nurse Practitioner Utilization Review jobs in Raleigh, NC? The most popular types of Nurse Practitioner Utilization Review jobs in Raleigh, NC are:
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What job categories do people searching Nurse Practitioner Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Nurse Practitioner Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Nurse Practitioner Utilization Review jobs? Cities near Raleigh, NC with the most Nurse Practitioner Utilization Review job openings:
Nurse Practitioner Utilization Review jobs near you
Infographic showing various Nurse Practitioner Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 68% Full Time, 21% Part Time, and 11% Contract. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $130,618 per year, or $62.8 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Other

Re-posted 20 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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