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

Corvel

Medical Case Manager II

Raleigh, NC · On-site

$66K - $101K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Corvel

Medical Case Manager II

Raleigh, NC

$66K - $101K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... Monitor daily census and assignment to assure all patients are assessed for case management needs ...

TalentClout

Be Seen First

Case Manager - ABA Therapy

Raleigh, NC · On-site

Case Manager -- ABA Center Full-Time | Competitive Pay + Comprehensive Benefits | On-Site Raleigh ... Monitor utilization data to review client programs and confirm consistent, reliable service ...

WakeMed

Mental Health Case Manager I

Raleigh, NC · On-site

Overview Supports patients and families in managing mental health and substance use concerns ... Assists with insurance appeals and utilization reviews. Supports clinical staff with coverage ...

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

Utilization Case Manager information

See Raleigh, NC salary details

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$35

$58

How much do utilization case manager jobs pay per hour?

As of Jun 29, 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 medical providers and insurance companies. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and clinical knowledge. Their goal is to optimize resource use while maintaining quality patient care.

What jobs pay 10,000 a month without a degree?

Utilization Case Managers typically do not earn $10,000 a month without specialized experience or certifications; most roles in this field pay lower salaries. High-paying jobs that can reach this level without a degree include sales, real estate, or entrepreneurship, often requiring strong skills, networking, and industry knowledge. Some trades, like certain construction or technical roles, may also offer high earnings with experience and certifications rather than formal degrees.

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 2000 a day?

Utilization Case Managers typically do not earn $2,000 a day; such high daily earnings are more common in specialized roles like senior executives, certain consulting positions, or high-level medical professionals. Most jobs with high daily pay require advanced skills, certifications, or extensive experience, and earnings can vary based on industry, location, and workload.

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 skills, familiarity with medical terminology, and sometimes certification. It provides experience in healthcare settings and can serve as a stepping stone to more advanced medical roles, but it may have limited responsibilities compared to specialized positions.

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

Medical Case Manager II

Corvel

Raleigh, NC • On-site

$66K - $101K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Key responsibilities

  • Provide in-person and telephonic medical case management to injured workers by involving patients, physicians, healthcare providers, employers, and referral sources.

  • Assess, plan, implement, and evaluate patients' progress and treatment plans for appropriateness, medical necessity, and cost effectiveness.

  • Attend provider visits, discharge planning conferences, and conduct home visits for initial evaluations and coordination of care.

CorVel rating

7.9

Company rating: 7.9 out of 10

Based on 51 frontline employees who took The Breakroom Quiz

81st of 139 rated financial services

Job description

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Raleigh/ Burlington, NC area.
Work from home, and on the road. Monday - Friday, regular business hours.
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
  • Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source
  • Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans
  • Provides assessment, planning, implementation, and evaluation of patient's progress
  • Evaluates patient's treatment plan for appropriateness, medical necessity, and cost effectiveness
  • Attends doctors, other providers, home and in some cases, attorney's visits
  • Attends hospital and/or long-term facility discharge planning conferences, etc. for the purpose of determining appropriateness of care and developing an effective long-term care strategy
  • Conducts home visit for initial evaluation
  • Implements care such as negotiating the delivery of durable medical equipment and nursing services
  • This role requires regular travel, dependent on the injured worker's injuries and needs. The employee must be available for local travel up to approximately 60% of the work week/month
  • This role may require overnight travel
  • Additional duties as required

KNOWLEDGE & SKILLS:
  • Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment
  • Ability to meet with the patient, their physicians, other healthcare providers, attorneys, advisors/clients, and coworkers
  • A cost containment background, such as utilization review or managed care is helpful
  • Strong interpersonal, time management, and organizational skills
  • Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets
  • Ability to work both independently and within a team environment

EDUCATION & EXPERIENCE:
  • Experience as an RN Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred
  • Graduate of accredited school of nursing
  • Current RN Licensure in state of operation
  • Certification as a CCM, CIRS, or other Case Management certifications preferred
  • A valid driver's license, reliable transportation, and ability to travel to assigned locations is required

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $66,941 - $101,258
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL - Medical Case Managers:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. In addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel's proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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