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

UNC HEALTH

RN Care Manager (Per Diem)

Chapel Hill, NC · On-site

$35.87 - $51.57/hr

Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services. 8. Accurately document and ...

UNC HEALTH

RN Care Manager (Per Diem)

Chapel Hill, NC · On-site

$35.87 - $51.57/hr

Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely approvals for necessary care and services. 8. Accurately document and ...

Elevance Health

Nurse Case Manager II

Durham, NC · On-site

$71K - $136K/yr

Assists with development of utilization/care management policies and procedures. Minimum Qualifications: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or ...

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Utilization Care Manager information

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$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
Population Health Care Manager- Rising Risk

Population Health Care Manager- Rising Risk

Duke University

Durham, NC • On-site

Full-time

Re-posted 14 days ago

Duke University rating

6.7

Company rating: 6.7 out of 10

Based on 55 frontline employees who took The Breakroom Quiz

436th of 555 rated colleges and universities

Job description

Duke Connected Care, a community-based, physician-led network, includes a group of doctors, hospitals and other healthcare providers who work together to deliver high-quality care to Medicare Fee-for-Service patients in Durham and itssurrounding areas.
General Description of the Job Class
The Population Health Care Manager is responsible for delivering clinical expertise to manage health care needs of specific patient populations across the continuum of care with a goal of improving patient health outcomes and reducing unnecessary utilization and cost. This role functions as an integral part of an interdisciplinary team and a patient's care team to optimize clinical outcomes through a seamless model of transitions, access, and care. This role focuses on improving the health status and connection to resources, preventive care, hospital follow-up, and ongoing healthcare for individuals with chronic health conditions as well as addressing frequent hospital and emergency department utilization, and medical, behavioral health, and psychosocial needs by performing care management and care coordination functions in a variety of settings that include a patient's home, community, and clinic.
These functions include:
  • Disease management and chronic disease support
  • Timely completion of clinical assessment and patient-centered care plan development, facilitation, and implementation
  • Transitional Care Management / care transition support inclusive of functions of placement into the right setting of care (e.g., skilled nursing, assisted living, home with caregiver support)
  • Assessment of and connection to resources and treatment for health, social, and behavioral needs
  • Patient activation and coordination for quality and preventive care gap closure
  • Assistance with and completion of medication reconciliation, access, education, and adherence
  • Duties and Responsibilities of this Level
  • Manages a designated caseload to complete timely development, completion, and implementation of assessments, care plans, and appropriate interventions for identified patient population to determine patient health, social situation, physical environment, behavioral health, substance use, expressed trauma, economic status, and education to patients while exercising discretion and independent judgment.
  • Provides individualized treatment plans to address barriers and identified concerns by accessing systematically identified data from multiple sources such as patient medical records, claims, and program metric reports to target recipient(s) and provider(s) for outreach, education, and intervention.
  • Performs targeted interventions to assist patients with connection to primary care providers and other health care resources.
  • Involves the patient and their support systems (i.e. caregiver, family, etc.) in the decision-making process. Uses a patient-centric, collaborative partnership approach to assist the patient with improved self-management and identifying barriers through a "whole-person" approach, inclusive of medical, psychosocial, behavioral, and spiritual needs.
  • Utilizes proven processes to measure a patient's understanding and acceptance of the proposed plan(s), his/her willingness to change, and his/her support to maintain health behavior change.
  • Applies teaching and learning theories to assist patients and families with physical and emotional impact of body changes and chronic illness.
  • Monitors quality and effectiveness of interventions to the population by setting long term and/or short-term specific, measurable goal(s).
  • Maintains timely documentation of all care management activity in Maestro, and other documentation systems relevant to the position.
  • Effectively communicates and coordinates with appropriate care team members to minimize fragmented care and foster appropriate utilization of services. This includes navigating transitions of care generally from hospital or facility to home or community facilities.
  • Facilitates interdisciplinary communication among care team members to include specialists, PCP, RN, psychiatrist and other key providers. Interfaces with key providers across the care continuum (e.g. discharge planners, social workers, physicians, psychiatrist, etc.) within the hospital, primary care practices, public health and social service departments, as well as behavioral health agencies and other community resources to assure that patients are linked to and engaged in services.
  • Provides on-site, community, and telephonic outreach to patients, providers, and community stakeholders assisting with identification of treatment history, diagnoses and patient care components both internally and externally to ensure that services provided are sensitive to the needs of individual patients and consider ethnic and cultural backgrounds.
  • Connects with patients and other care team members in a variety of settings, to include patient homes, community agencies and other locations, primary care practices, and telephone and other virtual platforms. This position may require home visits based on business rules and clinical need of identified patient population.
  • Participates in quality assurance/performance improvement activities as requested.
  • Provides feedback to Team Lead, management, and executive leadership that will enhance negotiations with payers, improve care management, and/or address gaps in care.
  • Develop and maintain positive relationships with customers internal and external to Duke Health System.
  • Provide other related duties incidental to the work described herein.

Required Qualifications at this Level
Education:
  • Bachelor's degree in Nursing or Master's degree that supports licensure by the NC Board of Licensed Clinical Mental Health Counselors (i.e., counseling, social work, allied/behavioral health).

Experience:
  • 3 years of relevant clinical experience required.

Degrees, Licensure, and/or Certification:
  • Candidates with a BSN must have current or compact RN licensure in state of NC
  • Candidates with a Master's degree (e.g., psychology, social work, counseling, or related behavioral health program) must have a current licensure by one of the following NC Boards: Licensed Clinical Social Worker (LCSW), Licensed Clinical Addiction Specialist (LCAS), or Licensed Clinical Mental Health Counselor (LCMHC)
  • All candidate/employees require a case management certification (ACM, CCM, or ANCC) within 3 years of hire

Knowledge, Skills, and Abilities:
  • Exceptional verbal/written communication and facilitation skills
  • Self-driven and able to work effectively in a self-directed role
  • Excellent problem-solving skills
  • Effectively able to manage multiple priorities in a fast-paced and evolving environment
  • Demonstrates basic computer skills to complete job functions

Distinguishing Characteristics of this Level
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
POPULATION HEALTH CARE MANAGER
Job Level: G2
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, itis essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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About Duke University

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Duke is regarded as one of America's leading research universities. Located in Durham, North Carolina, Duke is positioned in the heart of the Research Triangle, which is ranked annually as one of the best places in the country to work and live. Duke has more than 15,000 students who study and conduct research in its 10 undergraduate, graduate, and professional schools. With about 40,000 employees, Duke is the third largest private employer in North Carolina, and it now has international programs in more than 150 countries.

Industry

Colleges, universities, and professional schools and hospitals

Company size

10,000+ Employees

Headquarters location

Durham, NC, US

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