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

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. ...

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 ...

Case Manager

Raleigh, NC · On-site

$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 ...

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 ...

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 ...

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... for case management needs including care coordination/transition and discharge planning ...

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... for case management needs including care coordination/transition and discharge planning ...

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... for case management needs including care coordination/transition and discharge planning ...

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... for case management needs including care coordination/transition and discharge planning ...

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 ...

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 ...

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 ...

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 ...

It aims to promote continuity of care and cost effectiveness through the integration of case management, utilization review, and discharge planning. The Care Manager must be a highly organized ...

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Showing results 1-20

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 23, 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 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:
Infographic showing various Utilization Case Manager job openings in Raleigh, NC as of June 2026, with employment types broken down into 93% Full Time, 6% Part Time, and 1% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $73,772 per year, or $35.5 per hour.
Case Manager SE

$38.20 - $57.30/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago


Advocate Aurora Health rating

7.6

Company rating: 7.6 out of 10

Based on 772 frontline employees who took The Breakroom Quiz

189th of 889 rated healthcare providers


Job description

Department:
34033 Wake Forest Baptist Medical Center - Nursing: Care Coordination
Status:
Full time
Benefits Eligible:
Yes
Hours Per Week:
40
Schedule Details/Additional Information:
Various
Pay Range:
$38.20 - $57.30
The Case Manager, under the direction of the Director of Coordinated Care, utilizes the nursing process to develop, implement, and evaluate case management outcomes for defined patient populations. This individual supports the mission, vision, and values of Advocate Medical Center and contributes to the accomplishment of the purpose and objectives of the medical center. The Case Manager facilitates optimal outcomes for all parties involved through advocacy, objectivity and liaison/collaboration with an emphasis on continuity of care, effective communication, and coordination of appropriate healthcare services.
The Case Manager utilizes a variety of skills to educate, consult, and assist in the management of an identified patient population in order to achieve the highest quality and best possible outcomes for the patient in a cost effective manner. He/she collaborates with a patient care team that includes, but is not limited to physicians, nurses and assistive staff, rehabilitative therapies, respiratory therapy, pharmacy, dietetics, psychosocial support disciplines, infection control, fiscal services, performance improvement, and any other disciplines directly and indirectly involved in patient care.
The Case Manager utilizes a scientific approach in the analysis of patient care, identifying opportunities for the improvement of patient care/outcomes, quality of life, and cost reduction based on current research findings supported in the literature. Further, this individual collaborates actively on a daily basis (Monday-Friday) with the identified case management team in order to facilitate timely achievement of expected patient outcomes. When not on campus, the Case Manager is available by pager, digital phone, and e-mail.
The qualified candidate will possess the following:
A. Education
1. Graduate of an accredited School of Registered Professional Nurses, BSN preferred, MSN encouraged
B. 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. Current registration to practice as a Registered Nurse in the the applicable state as determined by job location
2. Case Management certification encouraged
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation
  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
  • Premium pay such as shift, on call, and more based on a teammate's job
  • Incentive pay for select positions
  • Opportunity for annual increases based on performance

Benefits and more
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

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About Advocate Health

Sourced by ZipRecruiter

Advocate Healthcare, based in Oak Lawn, Illinois, United States, is a leading figure in the health care industry. Accessible via their official website, 'advocatehealth.com', this organization provides a wide variety of medical services and treatment options. Founded in 1995 through a merger of Evangelical Health Systems Corporation and Lutheran General HealthSystem, Advocate Healthcare has grown exponentially over the years. Now, it operates more than 400 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, five Level I trauma centers, and three Level II trauma centers. Upholding their values of equality, compassion, excellence, partnership and stewardship, Advocate Healthcare's mission is centered on building lifelong relationships with patients by delivering the best health outcomes and highest level of service through an integrated approach to care and wellness.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Charlotte, NC, US