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Per Diem Optum Utilization Review Jobs in Raleigh, NC

UnitedHealth Group

Per Diem Social Worker

Durham, NC · On-site

$33.50 - $50.30/hr

As members of the Optum family of businesses, we are dedicated to helping people feel their best ... As the Social Worker - Per Diem, provides medical social services under the direction of a ...

UNC Health

Pharmacist (Per Diem)

Chapel Hill, NC · On-site

$51.50 - $74.01/hr

... reviews the patient's medication profile /history. Clarifies incomplete, inaccurate, or ... Per Diem Standard Hours Per Week: 8.00 Salary Range: $51.50 - $74.01 per hour (Hiring Range) Pay ...

UNC HEALTH

Pharmacist (Per Diem)

Chapel Hill, NC · On-site

$51.50 - $74.01/hr

... reviews the patient's medication profile /history. Clarifies incomplete, inaccurate, or ... Per Diem Standard Hours Per Week: 8.00 Salary Range: $51.50 - $74.01 per hour (Hiring Range) Pay ...

UNC HEALTH

Pharmacist (Per Diem)

Chapel Hill, NC · On-site

$51.50 - $74.01/hr

Responsibilities: 1. Receives prescriptions, interprets prescriptions, and reviews the patient ... Per Diem Standard Hours Per Week: 8.00 Salary Range: $51.50 - $74.01 per hour (Hiring Range) Pay ...

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Per Diem Optum Utilization Review information

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$20

$41

$67

How much do per diem optum utilization review jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for per diem optum 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 a Per Diem Optum Utilization Review?

A Per Diem Optum Utilization Review nurse is a registered nurse who works for Optum, typically on an as-needed or part-time basis, to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Their main responsibility is to review medical records and clinical information to determine if care meets established guidelines and policies, ensuring patients receive the right level of care while managing costs. These nurses often work remotely or in healthcare facilities, collaborating with providers, insurers, and patients to coordinate care and support quality outcomes.

How does a Per Diem Optum Utilization Review clinician typically collaborate with other healthcare professionals to ensure optimal patient care?

As a Per Diem Utilization Review clinician at Optum, you work closely with physicians, nurses, case managers, and insurance representatives to assess the medical necessity and appropriateness of patient care. Communication is often conducted via electronic health records, phone calls, and virtual meetings to discuss patient cases, clarify documentation, and support care transitions. Effective collaboration ensures compliance with regulatory standards and helps optimize patient outcomes, while also balancing cost-effectiveness. This role requires strong interpersonal skills and the ability to navigate complex cases with a multidisciplinary approach.

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

To excel as a Per Diem Optum Utilization Review Nurse, you typically need an active RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with electronic medical records (EMR), utilization management software, and knowledge of InterQual or MCG guidelines is important. Strong critical thinking, attention to detail, and effective communication are essential soft skills for reviewing cases and collaborating with providers. These skills ensure accurate, timely reviews that support appropriate patient care and compliance with payer and regulatory standards.

What is the difference between Per Diem Optum Utilization Review vs Per Diem Medical Reviewer?

AspectPer Diem Optum Utilization ReviewPer Diem Medical Reviewer
CertificationsLicensed healthcare professional (RN, MD, etc.)Licensed healthcare professional (RN, MD, etc.)
Work EnvironmentUtilization review for insurance and healthcare companiesReviewing medical records and authorizations
Employer & IndustryOptum/UnitedHealth Group, healthcare insuranceInsurance companies, healthcare providers
Search & Comparison IntentUnderstanding utilization review rolesComparing medical review positions

Both roles require licensed healthcare professionals and involve reviewing medical information. The main difference is that Per Diem Optum Utilization Review focuses on assessing the necessity of services for insurance purposes within Optum, while Per Diem Medical Review involves evaluating medical records for authorization or quality assurance in various healthcare settings.

What are the most commonly searched types of Optum Utilization Review jobs in Raleigh, NC?

The most popular types of Optum Utilization Review jobs in Raleigh, NC are:

What are popular job titles related to Per Diem Optum Utilization Review jobs in Raleigh, NC?

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

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

The top searched job categories for Per Diem Optum Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Per Diem Optum Utilization Review jobs?

Cities near Raleigh, NC with the most Per Diem Optum Utilization Review job openings:

Per Diem Optum Utilization Review jobs near you
Infographic showing various Per Diem Optum Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 12% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Representative I

Elevance Health

Durham, NC

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 days ago

Elevance Health rating

7.6

Company rating: 7.6 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

213th of 313 rated insurance

Job description

Anticipated End Date:

2026-08-31

Position Title:

Utilization Management Representative I

Job Description:

Utilization Management Representative I

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.


The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.

How you will make an impact:

  • Managing incoming calls or incoming post services claims work.

  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Checks benefits for facility based treatment.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

  • Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

  • Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.

  • Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

  • Performs other duties as assigned.

Minimum Requirements:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Inbound call center experience strongly preferred.

  • Medical terminology training and experience in medical or insurance field strongly preferred.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CUS > Care Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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