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Utilization Management Auditor Jobs in Raleigh, NC

GFL Environmental

Benefits Administrator

Raleigh, NC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Manage day-to-day operations of US group benefits programs, including medical, dental, vision ... Compile tracking, utilization, and compliance reports as needed. What We're Looking For ...

GFL Environmental

Benefits Administrator

Raleigh, NC · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Manage day-to-day operations of US groupbenefits programs, including medical, dental, vision, short ... Compile tracking, utilization, and compliance reports as needed. What We're Looking For ...

Conti Civil

Project Accountant

Raleigh, NC · On-site

$59K - $77K/yr

... and management, subcontractor invoicing, change orders, compliance auditing, and financial ... Reviews the weekly equipment charges and utilization reports. Discusses any variances with the ...

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All JobsUtilization Management Auditor JobsUtilization Management Auditor Jobs in Raleigh, NC

Utilization Management Auditor information

See Raleigh, NC salary details

$15

$31

$52

How much do utilization management auditor jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization management auditor in Raleigh, NC is $31.05, according to ZipRecruiter salary data. Most workers in this role earn between $21.73 and $39.47 per hour, depending on experience, location, and employer.

What is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing patient care needs and determining appropriate services

While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.

What are some common challenges faced by utilization management auditors and how can they be addressed?

Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.

What is a utilization management auditor?

A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.

What are the key skills and qualifications needed to thrive as a utilization management auditor?

To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
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What job categories do people searching Utilization Management Auditor jobs in Raleigh, NC look for? The top searched job categories for Utilization Management Auditor jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Management Auditor jobs? Cities near Raleigh, NC with the most Utilization Management Auditor job openings:
Utilization Management Auditor jobs near you
Infographic showing various Utilization Management Auditor job openings in Raleigh, NC as of June 2026, with employment types broken down into 1% Internship, 1% As Needed, 10% Full Time, 86% Part Time, 1% Contract, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $64,581 per year, or $31 per hour.

Charge Registered Nurse - RN

Fresenius Medical Care

Raleigh, NC • On-site

Full-time

Re-posted 16 days ago

Fresenius Medical Care rating

6.7

Company rating: 6.7 out of 10

Based on 1,327 frontline employees who took The Breakroom Quiz

531st of 887 rated healthcare providers

Job description

PURPOSE AND SCOPE:
Works with the Facility Manager, facility staff and physician to coordinate the facility operations and patient procedures to ensure provision of quality patient care on a daily basis in accordance with policies, procedures and training. Provides nursing support to patients and staff. Assists with staffing, staff training, equipment, physician and patient relations, cost containment, supply management, medical records, patient billing, OSHA and all company, state and federal compliance.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
QUALITY:
  • Responsible for supporting and driving quality standards through meeting regulatory requirements and the practice of Continuous Quality Improvement (CQI), including use of CQI tools.
  • Assists with implementing quality goals and develops facility specific action plans to achieve quality standards.
  • Accountable for outstanding quality of patient care, as defined by the quality goals, by working with management to ensure that policies and procedures are followed.
  • Assists with implementing appropriate training according to policy; ensure ongoing compliance with all risk management initiatives.
  • Responsible for aggressively addressing and acting on adverse events and action thresholds.
  • Ensures all Quality policies and procedures are communicated to and implemented by the facility staff.
  • Maintains integrity of medical records and other administrative and operational records.
  • Complies with all data collections and auditing activities.
  • Maintains facility environmental integrity, including safety.

PATIENT RELATED:
  • Coordinates all aspects of patient care with the appropriate staff members, from admission through discharge.
  • May confer with patients prior to the procedure to obtain necessary medical history, discuss procedure and answer questions, as well as, performs nursing assessment on the day of the procedure.
  • Ensures patients and patient's families are educated regarding post procedure care of vascular access.
  • Acts as a resource for the staff to address patient concerns and questions.
  • Ensures patient's procedures are scheduled in a timely manner and the facility capacity is utilized efficiently.
  • As needed, assist with patient workflow, including providing direct patient care and monitoring pre, intra and post procedure.
  • Identifies and communicates patient related issues to the Facility Manager.
  • Oversees and ensures accurate and complete documentation of patient treatments from admission to discharge.
  • Confirms written orders, consents and lab work are completed and documented in accordance with facility policies. This includes appropriate preparation of lab requisitions, delivery to appropriate labs, reporting and forwarding of lab results to appropriate physician.
  • Assumes primary responsibility in an emergency situation and must maintain competency with all emergency operational procedures, and initiate CPR and emergency measures as needed.
  • Administers medications and IV conscious sedation to patients as directed per physician's orders, and in compliance with, company, federal, state and local regulations.

PHYSICIANS:
  • Ensures regular and effective communication with all physicians on an as needed basis.
  • Attends and participates in Governing Body, assisting with meeting agenda and gathering of data/material for meetings.
  • Attends and participates in CQI meetings with physicians, reporting on assigned topics.
  • Works with the physicians and staff to ensure possession of all necessary instruments and equipment.

MAINTENANCE/TECHNICAL
  • Ensures appropriate operation of facility equipment and technology, including but not limited, patient monitors, defibrillators, medical recording devices and computers.
  • Ensures the inspection of all facility equipment on a regular basis. Report any malfunctions or maintenance issues immediately.
  • Ensures the inspection of all facility operating systems, including temperature checks in appropriate areas and inspect the physical structure of the facility.
  • Maintains a clean, safe and sanitary environment in the entire vascular access facility at all times.
  • Ensures all blood spills are immediately addressed according to company Bloodborne Pathogen Control Policies.

ADMINISTRATIVE:
  • Participates in cost control initiatives. Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve supply cost goals following all guidelines established in the formularies.
  • Assists in the development and revision of any applicable policies and procedures for the facility as directed to ensure continuous process improvement.
  • Initiates, documents and completes ongoing Continuous Quality Improvement (CQI) activities including monthly reports and attend meetings as required.
  • Manages medications, including ordering, receiving, and inventory control and checking for expired medications, including appropriate recording of controlled substances as required by law.
  • Oversees maintenance of usage logs for all medications with appropriate documentation, as well as, records of drug disposal. Communicates with the pharmacist to assure medication accuracy, including appropriate recording of controlled substances as required by law.
  • Ensures medical records are accurate, complete and in compliance with policies and procedures prior to discharge of the patient. Performs chart audits on a regular basis.
  • Along with Facility Manager, coordinates the annual medical testing and competency testing for all facility staff.
  • Participates in all facility regulatory and accreditation surveys and action plans to address any deficiencies identified.
  • Verifies records for all implanted devices are completed accurately, timely and maintained according to records management guidelines.
  • Coordinates the collection and forwarding of all vendor invoices to the accounting department.
  • Acts as the Facility Manager in the absence of the manager or at the direction of management.
  • Ensure nurses' progress notes are accurate and complete.
  • Acts as the Patient Safety Officer and conducts quarterly patient safety meetings and fire drills.
  • Complies with HIPPA policies and standards regarding patient information and medical records.
  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians.
  • The position requires travel between assigned facilities and various locations within the community. Travel to regional, Business Unit and Corporate meetings may be required.
  • The work environment is characteristic of a health care facility with air temperature control and moderate noise levels.
  • May be exposed to infectious and contagious diseases/materials.

SUPERVISION:
  • May be responsible for the direct supervision of various levels of direct patient care staff.

EDUCATION:
  • Bachelor's Degree preferred; Advanced Degree desirable
  • Graduate of an accredited School of Nursing (R.N.).
  • Current appropriate state licensure and ACLS certification.

EXPERIENCE AND REQUIRED SKILLS:
  • 6 - 8 years' related experience.
  • 3+ years' supervisory or project/program management experience preferred.
  • Minimum of three years' experience in an Ambulatory Surgical Center/Vascular Access Lab, or a combination of ASC, surgical, Interventional Radiology and ICU/CCU experience.
  • Minimum of three years of Interventional Radiology, scrub experience preferred.
  • Supervisory or management experience within a medical or vascular access environment preferred.
  • Proficiency with the Microsoft office suite is necessary. Experience with Medical database software.
  • Demonstrated management skills necessary to provide leadership and supervision of facility personnel and to ensure the delivery of maximum quality care to all patients.
  • Good communication skills - verbal and written.
  • Certified in CPR or successfully complete course in CPR certification

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.
Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

What Fresenius Medical Care employees say

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About Fresenius Medical Care

Sourced by ZipRecruiter

We are a Team of more than 70,000 with one guiding Principle Patients First. This promise starts with providing the most comprehensive care for people living with Chronic Kidney Disease and extends to Innovative Solutions that are redefining Healthcare and setting the industry standard. From evolving home Dialysis and Patient education programs to improving patient care to providing World Class Research and Data driven insights. Our vertically integrated network tirelessly seeks new ways to improve the quality of our Patients' lives. We believe each of us can make an impact and together we can change an industry. Our Mission is to Provide Superior care that improves the quality of life of every patient, every day, setting the standard by which others in the Healthcare Industry are judged. And none of us does it alone. We bring together the brightest minds in kidney care to Dream, Research, and Innovate.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Waltham, MA, US

Year founded

1996

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