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Senior Rn Utilization Review Nurse Jobs in Raleigh, NC

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel CVPICU RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN CVPICU for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: CVPICU * Discipline: RN * Start Date: 09/08/2026 * Duration: 13 ...

TNAA TotalMed RN

Travel ER RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: ED - Emergency Department * Discipline: RN * ...

TNAA TotalMed RN

Travel ER RN

Durham, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Durham, North Carolina. & Requirements * Specialty: ED - Emergency Department * Discipline: RN * ...

TNAA TotalMed RN

Travel Psychiatric RN

Louisburg, NC · On-site

$1.6K - $2.2K/wk

TNAA TotalMed RN is seeking a travel nurse RN Psychiatric for a travel nursing job in Louisburg, North Carolina. & Requirements * Specialty: Psychiatric * Discipline: RN * Start Date: 09/14/2026

Star Nursing, Inc.

Be Seen First

Registered Nurse RN

Butner, NC · On-site

$58/hr

Review admission requests for medical necessity * Ensure proper approvals and pre-certifications ... Support urgent and emergent admissions with utilization teams * Document all patient and transfer ...

TNAA TotalMed RN

Travel Emergency Dept RN

Louisburg, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Louisburg, North Carolina. & Requirements * Specialty: ED - Emergency Department * Discipline: RN * ...

TNAA TotalMed RN

Travel Emergency Dept RN

Louisburg, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Louisburg, North Carolina. & Requirements * Specialty: ED - Emergency Department * Discipline: RN * ...

TNAA TotalMed RN

Travel Home Health RN

Raleigh, NC · On-site

TNAA TotalMed RN is seeking a travel nurse RN Home Health for a travel nursing job in Raleigh, North Carolina. & Requirements * Specialty: Home Health * Discipline: RN * Duration: 13 weeks * 40 hours ...

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All JobsRn Utilization Review Nurse JobsSenior Rn Utilization Review Nurse JobsSenior Rn Utilization Review Nurse Jobs in Raleigh, NC

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 21, 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?

The most popular types of Rn Utilization Review Nurse jobs in Raleigh, NC are:

What are popular job titles related to Senior Rn Utilization Review Nurse jobs in Raleigh, NC?

For Senior Rn Utilization Review Nurse jobs in Raleigh, NC, the most frequently searched job titles are:

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The top searched job categories for Senior Rn Utilization Review Nurse jobs in Raleigh, NC are:

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Cities near Raleigh, NC with the most Senior Rn Utilization Review Nurse job openings:

Senior Rn Utilization Review Nurse jobs near you

Registered Nurse

Senior Helpers of North Raleigh

Knightdale, NC • On-site

$35 - $38/hr

Full-time

Re-posted 7 days ago

Job description

If you're looking for a home with a company where you can put your skills and experience to work, make a difference every day, and pursue your goals for the future, we look forward to hearing from you. Join our team!

We are an independently owned and operated Senior Helpers franchised business. Senior Helpers is the nation's premier provider of in-home senior services ranging from specialized care for those with diseases, such as dementia, Alzheimer's, and Parkinson's, to personal and companion care to help individuals looking for a little assistance with daily activities. Founded in 2002 with a vision to help seniors age with dignity despite age-related illnesses and mobility challenges, Senior Helpers has over 300 combined franchised-corporate store businesses that have cared for tens of thousands of seniors. Senior Helpers' culture is based on strong core values, recognition of achievements, and respect.

Duties

  • Complete documentation for nursing assessments, observations, and planning evaluations pertaining to clients
  • Regularly evaluate clients as necessary to ensure client needs are aligned with the care plan
  • Coordinate with management on implementing and revising operational procedures related to quality client care
  • Utilize professional assessment skills to identify the physical, mental, and psychosocial needs of client and be able to develop a care plan to meet these needs in a multi-disciplinary approach
  • Function as a resource and mentor to peers and subordinates to maintain professional nursing standards
  • Act on client’s behalf to ensure patient rights are respected
  • Be aware of home safety issues, strive to accomplish all responsibilities in a safe manner, and consistently reinforce good safety, attitude and practices displayed by other staff members
  • Respond promptly to any client complaints concerning a caregiver, document complaints, review complaints with the scheduling team, and take appropriate action with the caregiver
  • Coach staff in proper safety procedures and consistently reinforce
  • Lead client assessment process and initiate client onboarding following assessment, if applicable
  • Lead Caregiver Orientation and training sessions, weekly or as needed

Qualifications

  • Able to work as a team member
  • Able to maintain confidential information
  • Able to communicate effectively with company staff, the clients, and the client's families
  • Able to supervise (instruct, assign work, etc.) caregivers while on duty
  • Excellent verbal and communication skills, adaptable in different situations, and possess excellent client interaction skills
  • Able to multi-task and work independently
  • Availability during business hours and occasional evenings or weekends 

Requirements

  • Current Registered Nurse (RN) license in good standing.
  • Proven experience in primary care, geriatrics, or related fields.
  • Strong knowledge of diagnostic evaluation processes.
  • Experience working in inpatient settings, particularly within Level I or Level II Trauma Centers.
  • Excellent leadership, organizational, and communication skills.
  • Ability to work collaboratively within a multidisciplinary team environment.
  • Commitment to providing exceptional patient service and care.

Education and Experience

  • Current RN licensure
  • BLS certification
  • Must maintain CEU requirements as required by Board of Nursing
  • Bachelor of Science in Nursing (preferred)
  • 2 years nursing experience (preferred)
  • Homecare experience (preferred)

Benefits & Compensation

  • $35-38 per hour
  • Flexible schedule
  • Mileage reimbursement
  • Benefits available

Join our team as a Registered Nurse Manager and play a pivotal role in enhancing the quality of healthcare services provided to our patients.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state and local laws.

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