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Remote Utilization Management Jobs in Raleigh, NC

Director, Global Scaled CS

Raleigh, NC · Remote

$250K - $300K/yr

Value-to-Utilization Alignment: Monitor the health of the commercial base to identify and bridge ... or remote environment. * Technical Pedigree: Experience leading a TAM (Technical Account Manager ...

CUI Program Manager - Motion

Cary, NC · Remote

$108K - $109K/yr

Remote #LI-Remote You will be mainly accountable for: * Lead Motion's CUI compliance program ... Project Management Professional (PMP) certification, CMMC Certified Professional (CCP), CMMC ...

CUI Program Manager - Motion

Cary, NC · Remote

$114K - $114K/yr

Remote #LI-Remote You will be mainly accountable for: * Lead Motion's CUI compliance program ... Project Management Professional (PMP) certification, CMMC Certified Professional (CCP), CMMC ...

Pharmacy Access & Solutions Tech

Morrisville, NC · On-site +1

$19.78 - $28.12/hr

... utilization and optimization. The technician has a high level of autonomy working directly with ... This position is primarily remote, with occasional onsite attendance required for meetings ...

Conduct portfolio reviews with senior management and analyze existing portfolio to identify trends ... Understanding and utilization of credit skills for credit decision making, monitoring, and managing ...

Manager, Channel Marketing

Durham, NC · Remote

$130K - $160K/yr

Remote Department: Commercial Reports To: Associate Director, NA Marketing Communications Salary ... This role partners closely with brand marketing, sales, account management, and cross-functional ...

Machine Learning & Operations Engineer

Durham, NC · Remote

$71K - $96K/yr

This is a fully remote position, working cross-functionally with research and engineering teams ... Optimize GPU/compute utilization across cloud and on-prem environments. * Deploy, monitor, and ...

Machine Learning & Operations Engineer

Durham, NC · Remote

$67K - $90K/yr

This is a fully remote position, working cross-functionally with research and engineering teams ... Optimize GPU/compute utilization across cloud and on-prem environments. * Deploy, monitor, and ...

Machine Learning & Operations Engineer

Durham, NC · Remote

$67K - $90K/yr

This is a fully remote position, working cross-functionally with research and engineering teams ... Optimize GPU/compute utilization across cloud and on-prem environments. * Deploy, monitor, and ...

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Remote Utilization Management information

See Raleigh, NC salary details

$20

$41

$67

How much do remote utilization management jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote utilization management 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.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Raleigh, NC? The most popular types of Utilization Management jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Remote Utilization Management jobs? Cities near Raleigh, NC with the most Remote Utilization Management job openings:
Contractor (Statistical Healthcare Data Analyst), (Remote, CA & US)

Contractor (Statistical Healthcare Data Analyst), (Remote, CA & US)

Policy Reporter

Morrisville, NC • On-site, Remote

$44.37/hr

Full-time

Posted 19 days ago


Job description

Company Overview
Policy Reporter offers a suite of insights products and consulting services to enhance market access strategies and patient support initiatives. By tracking payer policies in near real time, we ensure that the largest pharmaceutical, medical device and diagnostics manufacturers, leading academic institutions and organized provider groups have the most up-to-date data and evidence-based guidance to help patients access the therapies they need. For more information, please visit https://www.policyreporter.com.
About the Team
The Data Analysis team at Policy Reporter plays a critical role in maintaining and enhancing the company's most valuable data assets, supporting both internal operations and client-facing solutions. The team applies advanced statistical methods and data engineering practices to analyze healthcare and population data, ensuring accuracy, integrity, and actionable insights. By collaborating cross-functionally with Product, Research, Engineering, Sales, and Customer Success, they help shape strategic initiatives and deliver custom analytics that drive smarter decisions. Their work directly supports Policy Reporter's mission to improve patient access to healthcare through timely, data-driven intelligence.
Position Summary
We are seeking a contractor to assist the Data Analysis Team Lead as a Statistical Healthcare Data Analyst at Policy Reporter by Valeris. In this contract position, you will support the development and maintenance of critical healthcare datasets, including Covered Lives and payer mapping tools. Reporting to the Data Analysis Team Lead, your work will involve data mining, cleanup, and analysis of healthcare and population data to drive insights and improve product delivery. You'll collaborate with internal teams to respond to client requests, onboard new users, and contribute to internal initiatives that enhance data accuracy and operational efficiency. This role also includes researching industry trends, summarizing complex healthcare documents, and supporting the development of pharmacy-related datasets. The ideal candidate should be able to commit between 20 - 40 hours per week.
Role & Responsibilities
Advanced data collection, cleanup, and analysis of healthcare and population data.
• Act as a subject matter expert on data sets managed by the Data Analysis (DA) team
• Utilize domain-specific knowledge to stay apprised of shifting payer landscape to ensure Policy Reporter's (PR) data remains accurate and up to date.
• Promote data democratization across the organization by building SQL queries and BI dashboards that detail customer utilization and report regularly to internal teams and leadership
• Take lead on new initiatives including data mining and writing R scripts to expedite DA tasks.
• Build and maintain BI dashboards in Amazon Quick Sight.
• Represent the DA team and take lead on analytics on interdepartmental projects, with support from team lead.
• Contribute to the presentation of deliverables to clients, both in written and verbal form.
• Use statistical and analytical knowledge to improve the quality of client deliverables.
• Scope, map out and document processes for new and recurring DA work.
• Build key data sets to enable operational and exploratory analysis.
• Work with Sales, Research, Product & Engineering Teams to improve the utility of the information stored within our database.
• Proactively look for ways to improve the quality of our datasets.
• Collaborate with internal teams to set standards for data processes within the company.
• Communicate narratives with data to many audiences, ranging from product managers to technical leads.
• Work with the Engineering team to support process improvements by acting as the DA subject matter expert.
Skills & Qualifications
• At least a Bachelor's degree in Information Management, Computer Science, Math, Statistics, or Analytics-focused discipline.
• 4+ Years' experience in similar roles.
• At least 3 years' experience using R and SQL for data processing and analysis.
• U.S. Healthcare knowledge is an asset.
• Expert English language skills (both written and verbal). A significant part of the job requires reading, understanding, and creating sophisticated documents.
• Ability to communicate complex subjects and ideas clearly.
• Ability to work independently and make consistent data decisions under ambiguity.
• Meticulous attention to detail and the ability to maintain focus.
• Intimate familiarity with Microsoft Office Suite is an asset.
Hourly Rate:
$44.37 CAD/ Hour
Policy Reporter's Core Values
  • Excellence
  • Value & Respect
  • Continuous Learning
  • Ownership & Accountability
  • Teamwork

We use AI tools to assist with application screening and to transcribe and summarize interview responses. These tools do not make decisions; all hiring decisions are made by human reviewers.
Department Data Analytics Locations Morrisville, Vancouver Remote status Fully Remote Hourly salary CAD44.37