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

Integrated Resources

RN-Care Manager

Chapel Hill, NC · On-site

Job Title: RN-Care Manager Location: Chapel Hill, NC 27514 Duration: 13 weeks Shift/Schedule: Days ... Perform case management, utilization review, and discharge planning activities. * Review daily ...

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 · 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 · 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 · 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.

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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 Aug 28, 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 is a utilization care manager?

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.

How does a utilization care manager 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 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 does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

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

RN-Care Manager

Chapel Hill, NC • On-site

Careers Integrated Resources Inc
See more jobs at Careers Integrated Resources Incexternal

Other

Posted 17 days ago

Job description

RN – Care Manager | Chapel Hill, NC

Location: Chapel Hill, NC Duration: 3+ Months Shift: Days | 8:00 AM – 5:00 PM

Job Summary

The RN Care Manager is responsible for coordinating patient care through comprehensive assessment, care planning, utilization review, discharge planning, and care transitions. This role focuses on improving patient outcomes, ensuring continuity of care, and promoting cost-effective treatment for acutely ill patients in an acute care hospital setting.

Key Responsibilities
  • Perform comprehensive patient assessments and develop individualized care plans.
  • Coordinate discharge planning and transition of care.
  • Conduct utilization review and case management activities.
  • Participate in daily Care Management Touchpoint (CAPP) meetings.
  • Attend weekly Complex Care Meetings (CCM) and collaborate on high-risk cases.
  • Identify and address barriers to discharge.
  • Coordinate with physicians, social workers, utilization managers, and multidisciplinary teams.
  • Educate patients and families regarding discharge plans and community resources.
  • Arrange post-acute services and obtain necessary authorizations.
  • Document assessments and care plans in Epic.
  • Monitor patient progression and expected discharge dates (EDD).
Required Qualifications
  • Active Registered Nurse (RN) license.
  • Minimum 2 years of healthcare experience as a Registered Nurse.
  • Recent Acute Care Hospital Case Management/Care Management/Discharge Planning experience.
  • Strong patient assessment and critical thinking skills.
  • Experience coordinating multidisciplinary care teams.
  • Proficiency with Epic EMR is preferred.
Must-Have Experience
  • Acute Care Hospital
  • RN Case Manager
  • Care Manager
  • Discharge Planning
  • Utilization Review
  • Care Coordination
  • Transition of Care
  • Complex Case Management
  • Interdisciplinary Collaboration
  • Epic Documentation

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