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Nursing Utilization Review Jobs in Raleigh, NC (NOW HIRING)

Actalent

Telehealth Nurse

Cary, NC · On-site

$30.75 - $40.75/hr

... utilization management in a clinical setting. * Oncology nursing or oncology and/or hematology ... reviewed using AI tools.

Star Nursing, Inc.

Registered Nurse RN

Butner, NC · On-site

$58/hr

Review admission requests for medical necessity * Ensure proper approvals and pre-certifications ... Support urgent and emergent admissions with utilization teams * Document all patient and transfer ...

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Work with the business office and the utilization review department to ensure payment for services ... Schedules CPEs, nursing assessments, H&P and psychosocial assessment with appropriate clinician and ...

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Work with the business office and the utilization review department to ensure payment for services ... Schedules CPEs, nursing assessments, H&P and psychosocial assessment with appropriate clinician and ...

Team Select Home Care

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

Participates in clinical record/utilization review of medical records and quality assurance and ... Immediately reports to Nursing Supervisor any patient incidents/variances or complaints

Team Select Home Care

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

Participates in clinical record/utilization review of medical records and quality assurance and ... Immediately reports to Nursing Supervisor any patient incidents/variances or complaints

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All JobsNursing Utilization Review JobsNursing Utilization Review Jobs in Raleigh, NC

Nursing Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do nursing utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for nursing utilization review 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 are the key skills and qualifications needed to thrive as a nursing utilization review nurse?

To thrive as a Nursing Utilization Review Nurse, you need strong clinical knowledge, critical thinking, and a current RN license, often complemented by experience in case management or utilization review. Familiarity with healthcare coding systems (ICD-10, CPT), utilization management software, and regulatory compliance tools is typical. Excellent communication, attention to detail, and negotiation skills make someone stand out in this position. These skills ensure accurate assessment of medical necessity, optimize resource use, and support patient care quality within regulatory guidelines.

What is nursing utilization review?

Nursing Utilization Review is a process where nurses evaluate the necessity, efficiency, and appropriateness of healthcare services provided to patients. These nurses review medical records, treatment plans, and patient progress to ensure that care meets established guidelines and is cost-effective. They play a key role in helping healthcare organizations maintain quality care while controlling costs and ensuring regulatory compliance. Utilization review nurses often work for hospitals, insurance companies, or government agencies.

What are some common challenges faced by nurses working in utilization review, and how can they be managed?

Nurses in utilization review often face challenges such as balancing the need for cost-effective care with advocating for patients' clinical needs and navigating complex insurance guidelines. They must critically review medical records while ensuring compliance with evolving regulatory standards. Effective time management and strong communication skills are essential for liaising between healthcare providers, insurance companies, and patients. Ongoing education and collaboration with interdisciplinary teams can help address these challenges and ensure high-quality, patient-centered care.

What is the difference between Nursing Utilization Review vs Nursing Case Management?

AspectNursing Utilization ReviewNursing Case Management
Primary FocusAssessing medical necessity and appropriateness of care for insurance or healthcare providersCoordinating patient care plans and ensuring optimal health outcomes
Work EnvironmentInsurance companies, healthcare facilities, utilization review organizationsHospitals, clinics, community health settings
CredentialsRN license, often with certifications in utilization review or case managementRN license, case management certification often preferred

While both roles involve nursing expertise, Nursing Utilization Review primarily focuses on evaluating the necessity of care for insurance purposes, whereas Nursing Case Management emphasizes coordinating patient care to improve health outcomes. Both roles require RN licensure and related certifications, but their daily tasks and work environments differ.

What are popular job titles related to Nursing Utilization Review jobs in Raleigh, NC?

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

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

The top searched job categories for Nursing Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Nursing Utilization Review jobs?

Cities near Raleigh, NC with the most Nursing Utilization Review job openings:

Nursing Utilization Review jobs near you
Infographic showing various Nursing Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Medical Director - Public Health (Tiered Sign-On Bonus up to $5,000)

County of Wake, NC

Raleigh, NC

Full-time

Posted 18 days ago

Job description

As the Medical Director for Wake County Public Health, you will be a key leader shaping the health and wellbeing of our community. In this role, you guide the clinical vision of the department and ensure our services align with the goals of Wake County, the Health Director, the Board of Commissioners, and state and federal mandates.

You will set the standard for medical excellence across Public Health, developing, implementing, and evaluating medical policies and clinical practice guidelines that strengthen care delivery. You'll serve as the primary physician for public health clinical services, providing medical orders, consultation, and direction to multidisciplinary teams. As a trusted partner to the broader medical community, you will build collaborative relationships that support population health goals and expand access to highquality care throughout Wake County.

You will also play a critical leadership role during urgent and emergent public health events, from communicable disease outbreaks to disaster response, helping guide clinical strategy and coordination during times when the community needs it most.

As a member of the Public Health Leadership Team, you will represent the department publicly through media interviews, community presentations, and participation on committees and workgroups, helping communicate important public health issues, priorities, and initiatives.

Essential Functions of the Medical Director include: 

Administration & Leadership

  • Serves as senior medical administrator supporting Public Health Director in advancing mission, culture, and strategic priorities.
  • Oversees all medical services across Public Health, ensuring integration and alignment across clinics, disciplines, and operational units.
  • Develops and enforces clinical policies, procedures, standing orders, and provider performance standards.
  • Provides oversight for physician/APRN recruitment, credentialing, supervision, and quality of clinical practice.
  • Supervises Provider Supervisors and provides medical oversight to clinical, laboratory, and pharmacy staff.
  • Conducts leadership rounding to assess team needs, support staff well-being, and improve workflows and patient experience.
  • Performs limited direct patient care as mutually agreed upon with department leadership.

Quality, Compliance & Risk Management

  • Ensures clinical operations consistently meet regulatory, legal, and ethical standards.
  • Leads evaluation of public health programs, quality assurance, utilization review, and costeffective service delivery.
  • Chairs the Human Subjects Review Panel, ensuring ethical research practices.
  • Collaborates with Occupational Health/ Infection Control Nurse to advise on compliance and safety matters.

Occupational Health, Safety & Infection Control

  • Provides oversight and guidance for employee health surveillance and occupational health program development.
  • Supports creation, implementation, and review of occupational health policies and infection control procedures.
  • Advises Health Director on emerging occupational health needs and compliance issues.

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