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

Select Source International

Case Manager

Durham, NC

$19.25 - $25/hr

Utilization and Quality Management/Outcomes experience preferred * Previous work experience with a managed care organization or provider is also preferred. * Prior experience in case management, home ...

Select Source International

Case Manager

Durham, NC · On-site

$19.25 - $25/hr

Utilization and Quality Management/Outcomes experience preferred * Previous work experience with a managed care organization or provider is also preferred. * Prior experience in case management, home ...

Duke University

Utilization Manager

Durham, NC · On-site

Ongoing collaboration with Case Manager to ensure that patient's condition meets medical necessity ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...

Duke Health

Utilization Manager

Durham, NC · On-site

Ongoing collaboration with Case Manager to ensure that patient's condition meets medical necessity ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...

Duke Health

Utilization Manager

Durham, NC · On-site

Ongoing collaboration with Case Manager to ensure that patient's condition meets medical necessity ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...

Duke University

Utilization Manager

Durham, NC

Ongoing collaboration with Case Manager to ensure that patient's condition meets medical necessity ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...

Duke Health

Case Manager Oncology

Durham, NC

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke University

Case Manager Oncology

Durham, NC

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke University

Case Manager Oncology

Durham, NC · On-site

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke Health

Case Manager Oncology

Durham, NC · On-site

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

Experience 1. Minimum of five years of experience in the care of assigned patient population 2. Participation in case management and utilization review encouraged C. Licensure/Certification 1. ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

Experience 1. Minimum of five years of experience in the care of assigned patient population 2. Participation in case management and utilization review encouraged C. Licensure/Certification 1. ...

Team Select Home Care

Case Manager

Raleigh, NC

$19.50 - $25/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

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

Utilization Case Manager information

See Raleigh, NC salary details

$16

$35

$58

How much do utilization case manager jobs pay per hour?

As of Jul 21, 2026, the average hourly pay for utilization case manager in Raleigh, NC is $35.47, according to ZipRecruiter salary data. Most workers in this role earn between $28.75 and $37.40 per hour, depending on experience, location, and employer.

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

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 with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

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

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Raleigh, NC? For Utilization Case Manager jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Raleigh, NC look for? The top searched job categories for Utilization Case Manager jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Case Manager jobs? Cities near Raleigh, NC with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Case Manager - Utilization Review

Case Manager - Utilization Review

Granville Health System

Oxford, NC • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 2 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

Case Manager - Utilization Review
Location: Granville Health System, Oxford NC

About Granville Health System:

For over a century, Granville Health System has been at the forefront of quality healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.

About Oxford, NC

Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters—perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.

Position Overview:
The primary role of the Case Manager is to review and monitor members’ utilization of health care services with the goal of maintaining high quality, cost-effective care. This role will provide the medical and utilization review expertise necessary to evaluate patient status.  This includes reviewing clinical information against established criteria, assessing the medical necessity of services and procedures, collaborating with providers and interdisciplinary teams, and ensuring that the patient is placed at the appropriate level of care from the time of admission. This includes providing referral authorization, concurrent review, proactive discharge/transition planning, appropriate referral to case management, and high-dollar claims review.

Position Highlights:

  • Retirement Benefits: NC Local Government Pension Plan (5-year vesting period)
  • Loan Forgiveness: Eligible employer for Public Service Loan Forgiveness (PSLF)
  • Comprehensive Benefits: Medical, dental, vision, life insurance, and various supplemental benefits available

Key Responsibilities:

• Conduct concurrent review of all patients, regardless of payer source, using approved screening criteria

• Perform admission reviews on the first working day following admission

• Conduct continued stay reviews at least every three (3) days or more frequently as indicated

Qualifications

Associate degree in a healthcare-related field or equivalent combination of healthcare experience and education.                                                                    

At least a year of experience in a related role (utilization review, case management, care coordination, insurance authorization/prior authorization, clinical documentation review, hospital patient access or revenue cycle support, healthcare quality or compliance functions).

Strong attention to detail, organizational skills and interpersonal skills.  Ability to interpret clinical documentation and apply review criteria.  Strong communication skills for interaction with physicians and interdisciplinary teams.  Knowledge of healthcare regulations and payer requirements

Preferred

Bachelor’s degree in Health Administration, Public Health, Social Work, Healthcare Management, or related field. Accredited Case Manager (ACM) certification. 

Experience with insurance authorization criteria preferred; one year utilization and discharge planning experience.

Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.

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