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Utilization Care Manager Jobs in Raleigh, NC (NOW HIRING)

Elwyn

Care Manager

Raleigh, NC · On-site

Responsibilities As a TCM Care Manager, you'll be the central point of contact for beneficiaries ... Analyze data to identify areas for improvement and ensure efficient utilization of resources.

Elwyn

Care Manager

Raleigh, NC · On-site

Responsibilities As a TCM Care Manager, you'll be the central point of contact for beneficiaries ... Analyze data to identify areas for improvement and ensure efficient utilization of resources.

Duke University

Utilization Manager

Durham, NC · On-site

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Complies with current rules and regulatory requirements pertaining to utilization management.

Duke Health

Utilization Manager

Durham, NC

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Complies with current rules and regulatory requirements pertaining to utilization management.

Duke Health

Utilization Manager

Durham, NC · On-site

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Complies with current rules and regulatory requirements pertaining to utilization management.

Duke University

Utilization Manager

Durham, NC

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Complies with current rules and regulatory requirements pertaining to utilization management.

Elwyn

Care Manager

Raleigh, NC · On-site

As a TCM Care Manager, you'll be the central point of contact for beneficiaries, ensuring their ... Analyze data to identify areas for improvement and ensure efficient utilization of resources.

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All JobsUtilization Care JobsUtilization Care Manager JobsUtilization Care Manager Jobs in Raleigh, NC

Utilization Care Manager information

See Raleigh, NC salary details

$37.9K

$88.5K

$162.8K

How much do utilization care manager jobs pay per year?

As of Jul 16, 2026, the average yearly pay for utilization care manager in Raleigh, NC is $88,470.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,800.00 and $106,400.00 per year, depending on experience, location, and employer.

What does a utilization manager do?

A utilization care manager evaluates healthcare services to ensure they are necessary, appropriate, and cost-effective. They review patient cases, coordinate with healthcare providers, and use medical records and guidelines to optimize resource use and improve patient outcomes.

How does a Utilization Care Manager typically collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are Utilization Care Managers?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience in patient communication, medical records, and office procedures, which can serve as a foundation for advanced healthcare roles. However, career growth may require additional certifications or training.

What jobs pay 4000 a week without a degree?

Utilization Care Managers typically do not earn $4,000 weekly without specialized experience or certifications. High-paying roles that can reach this level without a degree often include skilled trades such as commercial pilots, real estate brokers, or sales managers, which may require licensing or extensive experience. Most jobs paying this amount without a degree involve specialized skills, certifications, or significant experience in the field.

What are the key skills and qualifications needed to thrive as a Utilization Care Manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What is the highest paying healthcare administration job?

In healthcare administration, executive roles such as Chief Executive Officer (CEO), Chief Operating Officer (COO), and Chief Financial Officer (CFO) tend to have the highest salaries, often exceeding six figures annually. These positions require extensive experience, leadership skills, and often advanced degrees like an MBA or healthcare administration certification.
What are popular job titles related to Utilization Care Manager jobs in Raleigh, NC? For Utilization Care Manager jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Raleigh, NC look for? The top searched job categories for Utilization Care Manager jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Care Manager jobs? Cities near Raleigh, NC with the most Utilization Care Manager job openings:
Utilization Care Manager jobs near you
Care Manager

Care Manager

Community Care of North Carolina Inc

Cary, NC • On-site

Full-time

Re-posted 13 days ago

Job description

About CCNC:

From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high quality care.

CCNC Mission Statement:

To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems.


Position Summary

Address the needs of the population served by assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required by using communication and available resources to promote quality, cost-effective health outcomes.

Performing within the Registered Nurse and/or Licensed Clinical Social Work scope of practice, collaborate with the Primary Care Provider, member, guardian, caregivers, family members, other members of the Care Management Team, and the community to coordinate a full continuum of health care services. Holistic needs of the member, inclusive of unique social and cultural dynamics should be considered. The Care Manager may work remotely within regions to cover the needs across the state.


Care Manager(s) will serve the population within Regions 2, 4, and 6. Remote and travel will be required within the region and/or the State. Preferred to reside in the following County: Lenoir, Guilford, Randolph, Chatham, Jones, Carteret, and Pitt.


Essential Functions

  • Provide effective Care Management services based on case management standards of practice to enrolled populations.
  • Complete member assessments considering the total individual, inclusive of medical, biopsychosocial, behavioral, spiritual, and cultural needs to enrolled population, throughout the continuum of care.
  • Work with members to identify and address behavioral, social, cultural, and environmental strengths and barriers as it relates to his/her diagnosis, treatment, and access to care.
  • Provide education to member/family about clinical diagnosis, medications, available resources, prevention, and risk factors to achieve optimal self-management.
  • Monitor quality and effectiveness of interventions to the enrolled populations by setting patient-centered SMART goals in collaboration with the members/families.
  • Develop, review, implement, and evaluate the member care plan in partnership with the member, caregiver/guardian/family members, providers, and Care Management team members, as applicable.
  • Incorporate therapeutic skills and techniques such as trauma-informed care, motivational interviewing, strengths-based, and solution-focused modalities to help members achieve healing, growth, health, and wellness.
  • Utilize Hospital/Data or Electronic Medical Record system as available.
  • Per guidance, facilitate referrals for members/families to appropriate community-based services and agencies.
  • Refer to appropriate clinical team members for interventions which are outside the Care Managers’ scope of practice and/or expertise.
  • Work collaboratively with multi-disciplinary team members to facilitate achievement of desired treatment outcomes.
  • Engage and maintain collaborative relationships with community provider agencies that promote quality care and cost-effective health care utilization.
  • Serve as a liaison among the member/family/guardian, community services, primary providers, specialists, and other care team members to coordinate services without duplication.
  • Respect member’s values, experience, and help to empower members to be an advocate for their own care.
  • Maintain appropriate member documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
  • Meet monthly productivity and role expectations.
  • Understand, uphold, and abide by CCNC company and department policies, goals, standards, and objectives.
  • Adhere to CCNC privacy, security policies, and HIPAA regulations to ensure that patient and company data are properly safeguarded.
  • Attend departmental and corporate meetings, local and regional training, or other events as required.
  • Travel using personal vehicle will be required within the region and/or the State.
  • Perform all other duties as requested.


Qualifications

Registered Nurse (RN)

  • Graduation from an accredited school of nursing
  • BSN preferred
  • Active, unrestricted RN license to practice in North Carolina
  • Minimum 2 years’ nursing experience; 1-year care management or community-based nursing preferred
  • CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements
  • Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification
  • Access to Hospital/Data or Electronic Medical Record system will be required, as necessary
  • Maintain a valid driver’s license with current auto liability insurance


Social Worker

  • Master’s degree from an accredited school of social work
  • Minimum 2 years’ social work experience; 1-year case management or community-based social work preferred
  • Active NC license as a Licensed Clinical Social Worker (LCSW)
  • CCM certification preferred; will obtain within 1 year of eligibility per CCM requirements
  • Meets licensure or educational eligibility requirements as determined by The Commission for Case Management Certification
  • Access to Hospital/Data or Electronic Medical Record system will be required, as necessary
  • Maintain a valid driver’s license with current auto liability insurance


Knowledge, Skills, and Abilities

  • Computer skills required including various office software and the internet; experience with MS Office software preferred
  • Excellent communication skills – oral and written; Bilingual preferred
  • Knowledge of government, private sector, and community resources
  • Knowledge of Case Management principles
  • Knowledge of and compliance with federal and state regulations applicable to the position
  • Strong organizational and time management skills
  • Skills in establishing rapport with a member and applying techniques of assessing comprehensive health care needs
  • Critical thinking skills, effective clinical judgment, independent decision-making, and problem-solving abilities
  • Sensitivity to diversity of cultures, language barriers, health literacy, and educational levels
  • Ability to work independently and function as an integral part of a multi-disciplinary team
  • Responds to change with a positive attitude and a willingness to learn new ways to accomplish work activities and objectives
  • Able to shift strategy or approach in response to the demands of a situation


Working Conditions

  • The job environment is primarily an office or home environment
  • Multiple contacts, face to face and/or telephonic, are required with various members, providers, multi-payer systems and community partners to ensure coordination of services; exposure to general office and household conditions, as well as communicable disease could occur
  • Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
  • Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
  • Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds
  • Travel will be required within the region and/or the State


Why Join Us:

  • Make a meaningful impact on youth and families across North Carolina
  • Work with a supportive and collaborative care team
  • Competitive Benefits Package effective first day of employment
  • Opportunities for growth, training, and bonus incentives*

Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems?

  • Apply today and join us in delivering compassionate care that makes a difference.