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

ASK Consulting

Episodic Care Manager

NC · On-site +1

$29 - $39/hr

Episodic Care Manager Location: 100% Remote Duration: 5-6 Months Pay Range: $29-$39/hr. on W2 ( The ... Strong Utilization Review (UR)/medical necessity review experience, preferably from an insurance ...

New

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 ...

Atlantic BT

Digital Project Manager

Raleigh, NC · On-site +1

We provide a collaborative, remote-first environment where team members advance their skills across ... Lead project planning, milestone scheduling, and feature reviews prior to deployment. * Demonstrate ...

Atlantic BT

Digital Project Manager

Raleigh, NC · Remote

We provide a collaborative, remote-first environment where team members advance their skills across ... Lead project planning, milestone scheduling, and feature reviews prior to deployment. * Demonstrate ...

Tihinsurance

Senior Treasury Analyst

Raleigh, NC · Remote

English (Required) Work Shift: 1st Shift (United States of America) Please review the following ... This role is remote, but we would prefer someone in Charlotte, Dallas, Birmingham, New York ...

ABB

Data Center Tender/Quotation Specialist

Cary, NC · Remote

$16.75 - $22/hr

Remote {#LI-Remote} This role is contributing to the Electrification Services Division in the ... to review the plan of a particular ABB facility between the hours of 9:00 A.M. - 5:00 P.M. EST ...

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Remote Utilization Review information

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$20

$41

$67

How much do remote utilization review jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for remote 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 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 Raleigh, NC?

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

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

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

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

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

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

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

Infographic showing various Remote Utilization Review job openings in Raleigh, NC as of September 2026, with employment types broken down into 56% Full Time, 11% Temporary, and 33% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Episodic Care Manager

NC • On-site, Remote

ASK Consulting
See more jobs at ASK Consultingexternal

$29 - $39/hr

Full-time

Posted 3 days ago

New

Job description

Description
Job Title: Episodic Care Manager
Location: 100% Remote
Duration: 5-6 Months
Pay Range: $29-$39/hr. on W2 ( The compensation offered will be determined based on the candidate's qualifications, relevant experience, geographic location, and other applicable factors, and will fall within the posted pay range)
Job Responsibilities
  1. Review assigned inpatient, outpatient, DME, and behavioral health/substance abuse cases for medical necessity using medical policies, benefits, care guidelines, and regulations.
  2. Make authorization determinations and ensure reviews meet quality, accuracy, production, timeliness, and compliance standards.
  3. Communicate with members, providers, and internal/external clinical teams to obtain information and coordinate reviews.
  4. Escalate cases to the Medical Director (MD) when appropriate and coordinate peer-to-peer reviews as needed.
  5. Document review outcomes and accurately interpret, analyze, and summarize clinical information against applicable criteria/guidelines.
  6. Work primarily on substance abuse cases across all levels of care, determining whether services meet coverage and medical-necessity requirements.
Required Qualifications
  1. RN: 3+ years of clinical experience, or LPN: 5+ years of clinical experience.
  2. Valid NC or compact multi-state clinical license.
  3. 3-5+ years of experience; candidates without managed-care experience should have additional relevant experience.
  4. Strong Utilization Review (UR)/medical necessity review experience, preferably from an insurance/managed-care perspective.
  5. Experience with behavioral health, substance abuse, and/or eating disorder cases preferred.
  6. Working knowledge of UM systems and Outlook.
Nice to Have
  1. LCSW or other applicable behavioral health license.
  2. Social Worker/Utilization Review experience using NCG or internal insurance medical-necessity criteria.
  3. Experience working in both a clinical setting (e.g., detox facility) and an insurance/managed-care environment.

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