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Remote Utilization Management Jobs in Raleigh, NC

First Citizens Bank

AI Adoption Analyst

Raleigh, NC · On-site +1

$143K - $190K/yr

Overview This is a remote role that may only be hired in the following locations: NC, NY The AI ... Drive awareness, engagement, and utilization of AI capabilities across business functions * Develop ...

First Citizens Bank

AI Adoption Analyst

Raleigh, NC · On-site +1

$143K - $190K/yr

Overview This is a remote role that may only be hired in the following locations: NC, NY The AI ... Drive awareness, engagement, and utilization of AI capabilities across business functions * Develop ...

Abrigo

Senior Cloud Database Operations Engineer

Raleigh, NC · On-site +1

$93K - $127K/yr

The ideal candidate has deep experience managing SQL Server, MySQL, PostgreSQL, MongoDB, and ... This position will be located at our office in Raleigh, NC, Austin, TX, or remote. Occasional ...

Abrigo

Senior Cloud Database Operations Engineer

Raleigh, NC · On-site +1

$93K - $127K/yr

The ideal candidate has deep experience managing SQL Server, MySQL, PostgreSQL, MongoDB, and ... This position will be located at our office in Raleigh, NC, Austin, TX, or remote. Occasional ...

Hitachi

Transformer Diagnostic Specialist

Raleigh, NC · On-site +1

Engineering & Science Job Schedule: Full time Remote: No For our transformer service business ... You will support our customers in managing their transformer fleets throughout the asset lifecycle ...

BHDP Architecture

Designer | Architecture

Raleigh, NC · On-site +1

Hybrid (remote or in-office) Friday Employment Type: Full-time At BHDP, we believe great design ... Meets BHDP quality expectations through project coordination, accurate incorporation of manager ...

Aerotek

Proposal Writer

Raleigh, NC · On-site +1

... - 1 day remote Scope of Position The Proposal Writer is responsible for developing clear ... Utilization of Monday.com collaboration tool for project tracking and management * Support ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Raleigh, NC

Remote Utilization Management information

See Raleigh, NC salary details

$20

$41

$67

How much do remote utilization management jobs pay per hour?

As of Jul 21, 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 are popular job titles related to Remote Utilization Management jobs in Raleigh, NC? For Remote Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Raleigh, NC look for? The top searched job categories for Remote 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:
Remote Utilization Management jobs near you

Dental Consultant, Independent Contractor

Constellation Quality Health

Raleigh, NC • Remote

$125/hr

Other

Posted 25 days ago

Job description

Dental Consultant, Independent Contractor

Remote

Who We Are

Constellation Quality Health is a non-profit health care quality consultancy and QIO-like Entity certified by Centers for Medicare and Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle, we offer an array of quality improvement, clinical review, audit, technical, and consulting services and solutions to improve care delivery, system performance, and patient outcomes.

What Youll Do

The Dental Consultant supports Constellations payment integrity work, both directly and under contract with our partners. This position is responsible for conducting detailed reviews of clinical records to determine appropriateness of treatment, timelines and fact chronology, determination of reasonable and necessary treatment modality, causation, and medical necessity. This includes assessing consistency between diagnosis, procedures, and clinical documentation. The Dental Consultant works collaboratively with program staff to provide expert opinions on care provided to patients and develops formal, professionally written summaries of those opinions based on evidence and accepted practice standards as derived from a review of the supporting documentation.

We Expect You To:

  • Utilize best practices to assess dental documentation to determine causation, appropriateness of treatment, and determine medical necessity.
  • Review clinical documentation for reasonable and necessary treatment modalities including assessment of consistency between diagnosis, procedures, and other treatments.
  • Document expert opinion of clinical findings, assessment of care, and utilization of practice standards in a professionally written, formal summary report.
  • Respond to and/or attend hearings as required which may include some travel.

This position is contingent upon work assigned by the customer and works remotely on an as needed basis.

Our requirement for this role:

  • Licensed Dentist (DDS or DMD) in good standing
  • Minimum 3-5 years of experience in performing expert clinical review of treatment records including review of radiographs, procedure reports, treatment notes, and other records in support of causation
  • Demonstrated ability to communicate complex clinical information to diverse audiences.
  • Strong written, verbal, visual, and interpersonal communication skills.
  • Experience developing formal, professionally written reports which may be used during litigation.
  • Ability to manage multiple projects simultaneously and meet deadlines in a fast-paced environment.
  • Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, Outlook, Teams, and SharePoint) for documentation, reporting, data management, and administrative functions.

Compensation & Contract Terms

  • Hourly rate: From $125.00, per hour
  • This engagement is contingent upon contract award, satisfactory performance and mutual agreement.
  • The selected consultant will operate as an independent contractor and will not be considered an employee. The contractor will be responsible for their own taxes, insurance, benefits, and business expenses unless otherwise specified in a written agreement.
  • The selected consultant agrees to maintain and provide current certificates of coverage for professional liability insurance ($1M /$1M) and cyber liability insurance ($1M /$1M)

Constellation Quality Health is committed to equal opportunity and nondiscrimination in contracting opportunities. We do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, gender identity, national origin, medical condition, disability, veteran status, or any other basis protected by law.

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