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Remote Utilization Review Jobs in Durham, NC (NOW HIRING)

Senture

Medical Director

Raleigh, NC · Remote

While this position allows remote work, the individual must reside within the state of North ... Minimum three (3) years of experience supporting policy interpretation, utilization review ...

Centene

Psychologist Reviewer

Durham, NC · On-site +1

$87K - $157K/yr

Centene is Hiring - Remote Psychologist Reviewers (ABA) Centene is seeking Remote Psychologist ... Interact with network practitioners to provide education on best practice models and utilization ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...

First Citizens Bank

Principal Cloud Engineer

Raleigh, NC · Remote

$54.25 - $72.50/hr

Overview This is a remote role open for multiple markets across the United States. We are seeking a ... Optimize cluster performance and resource utilization. * Troubleshoot complex container, networking ...

First Citizens Bank

Principal Cloud Engineer

Raleigh, NC · Remote

$54.25 - $72.50/hr

Overview This is a remote role open for multiple markets across the United States. We are seeking a ... Optimize cluster performance and resource utilization. * Troubleshoot complex container, networking ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Durham, NC

Remote Utilization Review information

See Durham, NC salary details

$20

$40

$66

How much do remote utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote utilization review in Durham, NC is $40.86, according to ZipRecruiter salary data. Most workers in this role earn between $32.31 and $46.92 per hour, depending on experience, location, and employer.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

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

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

What are popular job titles related to Remote Utilization Review jobs in Durham, NC?

For Remote Utilization Review jobs in Durham, NC, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in Durham, NC look for?

The top searched job categories for Remote Utilization Review jobs in Durham, NC are:

What cities near Durham, NC are hiring for Remote Utilization Review jobs?

Cities near Durham, NC with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Durham, NC as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $84,983 per year, or $40.9 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 15 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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