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Rn Utilization Management Jobs in Raleigh, NC (NOW HIRING)

Duke Health

Utilization Manager 30 hour EOW

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Supports denials management by documenting activities related to denials adjudication according to ...

WakeMed

Care Coordinator, RN

Cary, NC · On-site

... federal, state and third-party utilization management regulatory requirements. Department ... EOE Licensure Registered Nurse Required Education Graduate Nursing Required - And Bachelor's Degree ...

WakeMed

Care Coordinator, RN

Raleigh, NC · On-site

... federal, state and third party utilization management regulatory requirements. Department ... EOE Licensure Registered Nurse Required Education Graduate Nursing Required - And Bachelor's Degree ...

CVS Health

Case Manager, Registered Nurse

Raleigh, NC · Remote

$54K - $155K/yr

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization ... A RN who resides in a compact state is required to have an active multistate license through the ...

Seven Healthcare

RN - Care Manager

Chapel Hill, NC

$1.9K/wk

Communicate with Care Management Assistant to share priorities * Attend CAPP and Complex Care ... Consult Social Worker and/or Utilization Manager as needed Requirements of the RN - Care Manager

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All JobsRn Utilization Management JobsRn Utilization Management Jobs in Raleigh, NC

Rn Utilization Management information

See Raleigh, NC salary details

$37.9K

$87K

$158.4K

How much do rn utilization management jobs pay per year?

As of Jun 16, 2026, the average yearly pay for rn utilization management in Raleigh, NC is $86,979.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,700.00 and $101,600.00 per year, depending on experience, location, and employer.

How does an RN Utilization Management professional typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

How to make $150,000 as a nurse?

Registered nurses in utilization management can reach a $150,000 salary by gaining specialized certifications, such as Certified Case Manager (CCM), and accumulating several years of experience in the field. Working in high-demand healthcare settings, taking on leadership roles, or pursuing advanced education like a master's degree can also increase earning potential.

What does a utilization management RN do?

A utilization management RN reviews medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure compliance with guidelines and optimize patient care while managing costs. Certification in case management or utilization review is often required, and the role typically involves working in a healthcare or insurance setting during regular business hours.

How to make 300,000 a year as a nurse?

To earn $300,000 annually as an RN in utilization management, nurses typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Combining leadership roles, overtime, or specialized skills can also increase earning potential.

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

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

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

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

How to make an extra 2000 a month as a nurse?

Rn Utilization Management professionals can increase income by taking on overtime shifts, working in high-demand specialties, or obtaining certifications like Certified Case Manager (CCM) to qualify for higher-paying roles. Additionally, some may pursue consulting or remote work opportunities that offer flexible schedules and higher pay rates.

What are RN Utilization Management nurses?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.
What are popular job titles related to Rn Utilization Management jobs in Raleigh, NC? For Rn Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Rn Utilization Management jobs in Raleigh, NC look for? The top searched job categories for Rn Utilization Management jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Rn Utilization Management jobs? Cities near Raleigh, NC with the most Rn Utilization Management job openings:
Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Raleigh, NC as of June 2026, with employment types broken down into 3% Internship, 91% Full Time, and 6% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $86,979 per year, or $41.8 per hour.

RN - Utilization Review & Care Coordination

MLee Medical Employment

New Hill, NC

Other

Posted 14 days ago

Job description

Overview: Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical necessity and appropriate treatment levels, collaborating closely with physicians and advanced practice providers.
Responsibilities: Conduct initial and concurrent utilization reviews for admitted and observation patients, ensuring compliance with regulatory and payer requirements. Partner with interdisciplinary teams to facilitate clinical guidelines and optimize treatment outcomes in a cost-effective manner. Analyze patient records to determine admission appropriateness, treatment plans, and length of stay. Maintain up-to-date knowledge of regulatory changes affecting utilization management and perform reviews accordingly. Manage denials and appeals in collaboration with management and payors, ensuring timely responses.
Education & Certification: Registered Nurse licensure is required. Certification in Case Management (CCM or ACM) is preferred.
Experience: Ideally, candidates will have three to five years of acute care nursing experience, with a background in medical/surgical or ICU settings. Experience in case management and managed care claims or reimbursement is advantageous.
Skills & Requirements: Strong clinical knowledge and understanding of nursing principles, clinical processes, and interventions. Excellent communication, negotiation, and interpersonal skills to effectively interact with diverse populations. Proficiency with computer systems including Microsoft Office and various healthcare software platforms. Ability to prioritize multiple tasks, demonstrate sound judgment, and work collaboratively with healthcare professionals at all levels. Flexibility and adaptability to change, with a positive approach to team building and respect.
Physical Demands: Some light lifting and walking may be required. The role involves extended periods of sitting and data entry.
This position serves a regional healthcare network in the Southeastern United States, providing comprehensive care across multiple facilities and specialties.

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