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Senior Rn Utilization Review Nurse Jobs in Raleigh, NC

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC · On-site

The Lead RN oversees nursing operations, supervises nursing staff, ensures compliance with nursing ... Participates in quality improvement, utilization review, infection control, and risk management ...

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC

The Lead RN oversees nursing operations, supervises nursing staff, ensures compliance with nursing ... Participates in quality improvement, utilization review, infection control, and risk management ...

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC · On-site

The Lead RN oversees nursing operations, supervises nursing staff, ensures compliance with nursing ... Participates in quality improvement, utilization review, infection control, and risk management ...

Duke Health

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

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Senior Rn Utilization Review Nurse information

See Raleigh, NC salary details

$20

$41

$67

How much do senior rn utilization review nurse jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for senior rn utilization review nurse 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 does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by a Senior RN Utilization Review Nurse when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.

What is the difference between Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What are the most commonly searched types of Rn Utilization Review Nurse jobs in Raleigh, NC?

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Senior Rn Utilization Review Nurse jobs near you

Utilization Review Nurse (RN)

Careers Integrated Resources Inc

Raleigh, NC • On-site

Other

Posted 6 days ago

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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