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Pediatric Utilization Review Jobs in Raleigh, NC

Case Manager SE

Wake Forest, NC ยท 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 ...

Case Manager SE

Wake Forest, NC ยท 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 ...

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Pediatric Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do pediatric utilization review jobs pay per hour?

As of Aug 22, 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.

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 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.

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

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

Infographic showing various Pediatric Utilization Review job openings in Raleigh, NC as of August 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.

Nursing Coordinator VAD - VAD Program

UNC HEALTH

Chapel Hill, NC โ€ข On-site

$38.55 - $55.43/hr

Full-time

Re-posted 14 days ago


Job description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.
Summary:
The VAD (Ventricular Assist Device) Nurse Coordinator coordinates the VAD care of all pediatric and adult VAD patients. The VAD Coordinator provides follow-up and care across the continuum from pre-VAD, during VAD implant admission and post VAD. S/he collaborates with members of the health care team to enhance patient care by developing, supporting and educating nursing staff. S/he is a clinician, educator, investigator, consultant and leader. S/he makes clinical judgments based upon a synthesis of current research, concepts, principles, theories, and outcomes to solve complex problems. The VAD Nurse Coordinator is an integral member of a larger multi-disciplinary team contributing to excellence in
patient care, research, teaching, and in providing leadership to the organization.
Responsibilities:
Collaborates with the VAD program administrator in short, intermediate, and long range planning for the VAD program through regularly scheduled staff and individual program meetings
Continuous Quality Improvement. Participates in the development, implementation and evaluation of the VAD program's CQI efforts that focus on maximizing the outcomes for patient survival and quality of life. Reviews patient resource utilization with administrative and clinical staff to identify areas for improvement. Participates in the development and improvement of clinical pathways.
Education. Educates patients and their families about the VAD process and what to expect during each phase of care (pre, peri, and post). Responsible for planning and acquiring or designing educational materials, and presenting educational programs to patients and staff, other professionals, the community and outside agencies.
Patient Care- Oversees and/or coordinates the clinical, psychosocial and financial needs of the VAD patient. Coordinates evaluation tests and consults to determine VAD candidacy and facilitates VAD by organizing patient and VAD team. Monitors inpatient status, discharge needs and follow-up care per program standards
Regulatory Compliance. Documents and maintains patient VAD information in the electronic medical record with current data and required information to ensure regulatory compliance.
Other Information
Other information:
Education Requirements:
โ€ข Bachelor's degree in Nursing (BSN) from a state-accredited school of professional nursing.
Licensure/Certification Requirements:
โ€ข Licensed to practice as a Registered Nurse in the state of North Carolina.
Professional Experience Requirements:
โ€ข Three (3) years of professional nursing experience to include two (2) years in VAD or transplant, critical care, disease specific area.
Knowledge/Skills/and Abilities Requirements:
Job Details
Legal Employer: STATE
Entity: UNC Medical Center
Organization Unit: Lung Pre-Transplant
Work Type: Full Time
Standard Hours Per Week: 40.00
Salary Range: $38.55 - $55.43 per hour (Hiring Range)
Pay offers are determined by experience and internal equity
Work Assignment Type: Hybrid
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: Yes
This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.