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Pediatric Utilization Review Jobs in Raleigh, NC

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... case management and utilization review encouraged C. Licensure/Certification 1. Current ... pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... case management and utilization review encouraged C. Licensure/Certification 1. Current ... pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized ...

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

Pediatric Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do pediatric utilization review jobs pay per hour?

As of Jul 28, 2026, the average hourly pay for pediatric 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.

Can you become a utilization reviewer without being a nurse?

Pediatric utilization review roles typically require a nursing background or healthcare-related experience, as they involve assessing medical necessity and reviewing patient care. While some positions may accept other healthcare professionals with relevant training or certifications, most employers prefer candidates with nursing credentials or clinical experience. Knowledge of medical coding, insurance policies, and utilization review software is also beneficial.

What are some common challenges faced by pediatric utilization review professionals, and how are they addressed?

Pediatric utilization review professionals often encounter challenges such as balancing the need for cost-effective care with advocating for the unique clinical needs of children. They must navigate complex insurance guidelines while collaborating closely with physicians, case managers, and families to ensure children receive appropriate and timely care. Staying updated on evolving pediatric treatment protocols and regulatory requirements is also essential. Strong communication skills and a thorough understanding of pediatric standards help address these challenges and promote positive patient outcomes.

How to become a utilization review specialist?

To become a utilization review specialist, typically one needs a relevant healthcare background such as nursing, health administration, or a related field, along with experience in medical coding or insurance. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or a similar credential can enhance job prospects, and strong analytical and communication skills are essential for reviewing medical necessity and treatment plans.

What is the highest paid pediatric job?

In pediatric healthcare, pediatric specialists such as pediatric cardiologists, pediatric intensivists, and pediatric surgeons tend to have the highest salaries. Pediatric utilization review roles generally offer competitive pay, but specialized physicians in pediatric subspecialties typically earn the highest compensation within pediatric jobs.

What are alternative careers with a pediatric background?

With a pediatric background, alternative careers include pediatric nurse, child life specialist, pediatric social worker, pediatric physical or occupational therapist, and pediatric healthcare administrator. These roles often require relevant certifications, clinical experience, and knowledge of child development and healthcare policies.

What is pediatric utilization review?

Pediatric utilization review is a process in healthcare where specialists assess the necessity, appropriateness, and efficiency of medical services provided to children. The goal is to ensure that pediatric patients receive the right care at the right time, while avoiding unnecessary treatments or procedures. Utilization review professionals review medical records, treatment plans, and insurance information to make informed decisions about coverage and care. This process helps control healthcare costs and maintain high standards of care for young patients.

What are the key skills and qualifications needed to thrive as a Pediatric Utilization Review nurse, and why are they important?

To excel as a Pediatric Utilization Review nurse, you need a solid clinical background in pediatrics, a current RN license, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and industry certifications like Certified Case Manager (CCM) are often required. Strong analytical skills, attention to detail, and effective communication help you collaborate with healthcare teams and advocate for appropriate care. These competencies ensure that pediatric patients receive necessary, cost-effective treatment while maintaining compliance with regulatory standards.

What is the difference between Pediatric Utilization Review vs Pediatric Case Manager?

AspectPediatric Utilization ReviewPediatric Case Manager
CredentialsTypically requires nursing or healthcare-related certificationsRequires nursing, social work, or healthcare certifications
Work EnvironmentReviewing medical records and insurance claims, often remotely or in officeDirect patient interaction, coordinating care, often in clinical or community settings
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, clinics, community health agencies

While both roles focus on pediatric healthcare, Pediatric Utilization Review primarily involves evaluating medical necessity and insurance claims, whereas Pediatric Case Managers coordinate ongoing patient care and support families directly. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Pediatric Utilization Review jobs in Raleigh, NC? For Pediatric Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Pediatric Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Pediatric Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Pediatric Utilization Review jobs? Cities near Raleigh, NC with the most Pediatric Utilization Review job openings:
Pediatric Utilization Review jobs near you
Infographic showing various Pediatric Utilization Review job openings in Raleigh, NC as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $85,491 per year, or $41.1 per hour.
RN Pediatric Clinical Educator

RN Pediatric Clinical Educator

BAYADA Home Health Care

Raleigh, NC

$80K - $83K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Bayada Home Health Care rating

7.0

Company rating: 7.0 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

417th of 890 rated healthcare providers

Job description

BAYADA Home Health Care has an immediate opening for a Clinical Educator in our Raleigh, NC Pediatric Office. This role has a strong hands-on focus on leading and facilitating clinical simulation scenarios in our skills labs, making it ideal for an educator who is passionate about experiential learning and clinical excellence.

If you are looking for an exciting career opportunity in a growing industry, a Clinical Educator role at BAYADA could be the position for you.

Do you want to be part of providing care with the highest professional, ethical, and safety standards? Do you enjoy teaching through real-world, scenario-based learning? Do you want to use your leadership and mentoring skills to make a difference in people’s lives? We are BAYADA Home Health Care, and we believe that our clients and their families deserve care delivered with compassion, excellence, and reliability. Your work will help ensure that our caregivers are confident, competent, and well-prepared to deliver exceptional care in the home setting.

Clinical Educators at BAYADA play a critical role in supporting and developing our field staff. The primary responsibility of this role is planning, leading, and evaluating clinical simulation scenarios within our lab environment to enhance caregiver readiness, clinical judgment, and patient safety.

Clinical Educator Qualifications include:

  • Current RN license in good standing
  • BSN/MSN preferred
  • Minimum two years of staff development or nursing education experience
  • Experience developing performance improvement plans, field staff orientation, clinical chart review, and utilization review reporting
  • Strong assessment and organizational skills
  • Experience working with the pediatric population and tracheostomies and ventilators
  • Demonstrated successful track record of working independently while taking on increased or diverse responsibilities
  • Ambition to grow and advance beyond current position

Bayada Offers Clinical Educators:

  • Base Salary: $80,000- $83,000 / year depending on qualifications

Why you'll love BAYADA:

  • BAYADA Home Health Care offers the stability and structure of a national company with the values and culture of a family-owned business.
  • Award-winning workplace: proud to be recognized as a Best Place to Work by Newsweek, Forbes, and Glassdoor.
  • Weekly pay
  • AMAZING culture: we are a mission driven nonprofit organization, focused around three core values of compassion, reliability, and excellence.
  • Strong employee values and recognition: we utilize a BAYADA Celebrates page for daily recognition, along with Hero spotlights, Key Action of the Week meetings to connect back to our mission and celebrate staff, discounts/perks and partnerships, an Awards Weekend trip, and more.
  • Diversity, equity, inclusion, and belonging: Join groups like our Women in Limitless Leadership Employee Resource Council, Lean In circles, Racial and Ethnic Diversity (RED) Council, Pride LGBTQIA+ Council, Military Community Network, Solutions and Accessibility for Equality (SAFE) Council, Fostering Acceptance Inspiring Trust and Harmony (F.A.I.T.H), and more.
  • Growth opportunities: advancement opportunities, continued education opportunities, Udemy courses, webinars, and more
  • Check out our blog: https://www.bayada.com/search?q=Newsweek
  • Benefits: BAYADA Home Health Care offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance program. To learn more about BAYADA Home Health Care benefits, https://www.bayada.com/benefits

#LIRX

As an accredited, regulated, certified, and licensed home health care provider, BAYADA complies with all state/local mandates.

BAYADA is celebrating 50 years of compassion, excellence, and reliability. Learn more about our 50th anniversary celebration and how you can join in here.

BAYADA Home Health Care, Inc., and its associated entities and joint venture partners, are Equal Opportunity Employers. All employment decisions are made on a non-discriminatory basis without regard to sex, race, color, age, disability, pregnancy or maternity, sexual orientation, gender identity, citizenship status, military status, or any other similarly protected status in accordance with federal, state and local laws. Hence, we strongly encourage applications from people with these identities or who are members of other marginalized communities.

What Bayada Home Health Care employees say

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About Bayada Home Healthcare

Sourced by ZipRecruiter

BAYADA has a special purpose: to help people of all ages have a safe home life with comfort, independence, and dignity. We believe our clients and their families deserve the highest quality home health care delivered with compassion, excellence, and reliability - our core values, affording them the opportunity to remain at home and receive the medical care required.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Moorestown, NJ, US

Year founded

1975

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