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Senior Rn Utilization Review Nurse Jobs in Raleigh, NC

Duke University

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 ...

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 ...

Duke University

Utilization Manager

Durham, NC

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 ...

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 ...

Rose Manor Health and Rehab

MDS Coordinator (RN)

Durham, NC · On-site

$33.75 - $40.75/hr

... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...

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Senior Rn Utilization Review Nurse information

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$20

$41

$67

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

As of Jul 25, 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 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.

Can I make $500,000 as a nurse?

Senior Rn Utilization Review Nurses typically earn salaries ranging from $80,000 to $120,000 annually, depending on experience, location, and employer. Earning $500,000 is uncommon in this role and usually requires additional responsibilities, bonuses, or working in high-paying regions or specialized settings.

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.

How to make 150,000 as a nurse?

Senior Rn Utilization Review Nurses can earn $150,000 by gaining extensive experience, obtaining advanced certifications such as CCM or ANCC, and working in high-paying settings like hospitals or insurance companies. Increasing responsibilities, working overtime, or taking on leadership roles can also boost income in this field.

What are some typical challenges faced by Senior RN Utilization Review Nurses 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.

How to make $200,000 a year as a nurse?

Senior Rn Utilization Review Nurses can reach a $200,000 annual salary by gaining extensive experience, obtaining advanced certifications, and working in high-paying settings such as insurance companies or specialty healthcare organizations. Developing expertise in case management, health policy, and utilizing clinical judgment can also increase earning potential, often supplemented by overtime or leadership roles.

How to get into utilization review as a nurse?

To become a utilization review nurse, typically a registered nurse (RN) must have clinical experience and obtain knowledge of insurance policies and healthcare regulations. Certification in case management or utilization review, such as the Certified Case Manager (CCM) credential, can enhance job prospects. Strong analytical skills, attention to detail, and familiarity with electronic health records (EHR) systems are also important for this role.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Raleigh, NC? The most popular types of Rn Utilization Review Nurse jobs in Raleigh, NC are:
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Senior Rn Utilization Review Nurse jobs near you
Utilization Review Nurse

Utilization Review Nurse

Granville Health System

Oxford, NC

Other

Posted 4 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Position Summary:

Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.

Qualifications:

North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.

What Granville Health System employees say

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Hours and flexibility

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