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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

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 ...

Humana

Compliance UM Nurse (Wed - Sun)

Raleigh, NC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Become a part of our caring community The Compliance Nurse 2 reviews utilization management ... Licensed Registered Nurse (RN) in a compact state with no disciplinary action.?? * Must have?valid ...

American Traveler

Travel RN Care Manager

Chapel Hill, NC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

Actalent

Telehealth Nurse

Cary, NC · On-site

$30.75 - $40.75/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Telehealth Oncology Registered Nurse This telehealth oncology nursing role focuses on counseling ... Experience in telehealth, triage, or utilization management in a clinical setting. * Oncology ...

UMR

Full Time Registered Nurse

Chapel Hill, NC · On-site

Registered Nurse In Home Health Explore opportunities with Suncrest Home Health, a part of LHC ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

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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 Aug 12, 2026, the average yearly pay for rn utilization management in Raleigh, NC is $86,984.00, 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 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 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 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 insurance policies and healthcare regulations. 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 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.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

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 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 August 2026, with employment types broken down into 2% As Needed, 77% Full Time, 14% Part Time, 2% Temporary, and 5% Contract. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $86,984 per year, or $41.8 per hour.

Utilization Review Nurse (RN)

Careers Integrated Resources Inc

Raleigh, NC • On-site

Other

Posted 2 days ago

New

Job description

Utilization Review Nurse (RN)

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.

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