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

Integrated Resources

RN-Care Manager

Chapel Hill, NC · On-site

RN - Care Manager | Chapel Hill, NC Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8 ... Conduct utilization review and case management activities. * Participate in daily Care Management ...

WakeMed Health

Patient Flow Coordinator, RN

Raleigh, NC · On-site

$17 - $22.25/hr

Patient Flow Coordinator, RN The Patient Flow Coordinator, RN assists in facilitating the admission ... utilization management regulatory requirements. The Capacity and Transfer Management Center ...

TotalMed RN

Travel RN Care Manager

Chapel Hill, NC · On-site

Case Management * Discipline: RN * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel We're looking for RN Case managers for an immediate travel nurse opening in ...

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Rn Utilization Management information

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$37.9K

$87K

$158.4K

How much do rn utilization management jobs pay per year?

As of Sep 14, 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.

What is an RN Utilization Management?

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 skills and qualifications are needed to thrive as an RN Utilization Management?

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.

How does an RN Utilization Management 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.

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 get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of healthcare policies and insurance processes. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

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 September 2026, with employment types broken down into 4% As Needed, 78% Full Time, 10% Part Time, 6% Contract, and 2% Nights. Highlights an 94% In-person, 2% Hybrid, and 4% Remote job distribution, with an average salary of $86,979 per year, or $41.8 per hour.

Utilization Review Nurse (RN)

Raleigh, NC • On-site

Integrated Resources INC
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Integrated Resources INCexternal

Contractor

Re-posted 17 days ago

Job description

Company Description

A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care.

Advanced assessment and teaching skills.

Problem solving skills.

Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues.

Utilization and Quality Management/Outcomes experience preferred.

Previous work experience with a managed care organization or provider is also preferred.

Prior experience in case management, home health, discharge planning, or Concurrent review.



Qualifications

RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree.

Minimum of 3 years clinical experience in an acute medical or acute surgical setting.

Proficiency with a Microsoft Windows operating system.

Must have valid license to practice nursing within the US and have started application for NC nursing license. 

Additional Information

With Regards,


Kavita Kumari

Allied Healthcare Recruiter

Integrated Resources, Inc

IT REHAB CLINICAL NURSING

Inc. 5000 - 2007-2014 (8th Year)

Certified MBE I GSA - Schedule 66 I GSA - Schedule 621I I GSA - Schedule 70

Tel: 732-549-2030 x208

Fax: 732-549-5549

Direct: 732-549-5302




Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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