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Utilization Management Jobs in Cary, NC (NOW HIRING)

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. * Maintain timely documentation of assessment findings ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. * Maintain timely documentation of assessment findings ...

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Showing results 21-40

All JobsUtilization Management JobsUtilization Management Jobs in Cary, NC

Utilization Management information

See Cary, NC salary details

$36.1K

$82.9K

$151K

How much do utilization management jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization management in Cary, NC is $82,898.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,800.00 and $96,800.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are popular job titles related to Utilization Management jobs in Cary, NC?

For Utilization Management jobs in Cary, NC, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Cary, NC look for?

The top searched job categories for Utilization Management jobs in Cary, NC are:

What cities near Cary, NC are hiring for Utilization Management jobs?

Cities near Cary, NC with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Cary, NC as of August 2026, with employment types broken down into 95% Full Time, and 5% Contract. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $82,898 per year, or $39.9 per hour.

Sr Clinical Pharmacist

Blue Cross And Blue Shield of North Carolina

Durham, NC

$114K - $136K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 16 days ago

Key responsibilities

  • Serve as the strategic clinical pharmacy lead and primary pharmacy advisor for a large employer client.

  • Develop, communicate, and execute pharmacy benefit strategies related to formulary design, utilization management, clinical programs, and emerging drug trends.

  • Partner with internal teams and client stakeholders to ensure successful delivery of pharmacy benefit solutions and achievement of client objectives.

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

196th of 315 rated insurance

Job description

Job Description

We are hiring for a Senior Clinical Pharmacist! This individual will serve as the strategic clinical pharmacy lead and primary pharmacy advisor for a large employer client. You will be responsible for developing, communicating, and executing pharmacy benefit strategies that optimize clinical outcomes, member experience, and total cost of care. You will also acts as the primary clinical liaison between Blue Cross NC and client stakeholders, providing leadership across formulary management, utilization management, clinical programs, rebate strategy, and pharmacy operations. Also, this individual will partner closely with internal pharmacy, medical, finance, analytics, operations, and account management teams to ensure successful delivery of pharmacy benefit solutions and achievement of client objectives.

What You'll Do

  • Serve as the strategic clinical pharmacy lead and trusted advisor for a large employer client, providing consultation and recommendations on pharmacy benefit strategy and performance.
  • Develop and communicate pharmacy benefit strategies related to formulary design, utilization management, specialty pharmacy, clinical programs, and emerging drug trends.
  • Collaborate with client leadership and internal stakeholders to align pharmacy strategies with business objectives, affordability goals, and member health outcomes.
  • Lead and support client-facing meetings, quarterly business reviews, strategic planning sessions, and executive presentations.
  • Evaluate pharmacy trend drivers, utilization patterns, pipeline therapies, and market developments to identify opportunities for program optimization.
  • Provide clinical leadership and oversight for formulary management initiatives, utilization management programs, and evidence-based coverage strategies.
  • Partner with rebate and financial teams to evaluate manufacturer contracting opportunities and rebate strategies that support client objectives.
  • Support the development, implementation, and monitoring of clinical programs including specialty pharmacy management, site-of-care optimization, preventive medication strategies, and drug utilization initiatives.
  • Collaborate with pharmacy operations teams to ensure successful implementation and ongoing management of pharmacy benefit programs.
  • Analyze and present clinical and financial performance metrics, identifying emerging risks, opportunities, and recommended actions.
  • Ensure compliance with applicable regulatory, accreditation, and quality requirements related to pharmacy benefits.
  • Serve as a subject matter expert for internal business partners, sales teams, account management teams, and executive leadership.
  • Maintain awareness of industry trends, emerging therapies, regulatory developments, and innovative pharmacy benefit solutions.

What You Bring

  • Doctor of Pharmacy (PharmD) degree
  • In lieu of degree, 10+ years of experience in related field.
  • Active pharmacist license in North Carolina or ability to obtain licensure prior to hire.

Bonus Points(Preferred Qualifications)

  • 5+ years of managed care, health plan, PBM, or employer pharmacy consulting experience.
  • Experience serving as a dedicated clinical lead for a large employer, government, or public-sector client.
  • Proven experience leading complex pharmacy initiatives involving multiple stakeholders and cross-functional teams.
  • Demonstrated experience presenting and consulting with executive-level clients and external stakeholders.
  • Strong experience with formulary management, utilization management strategy, pharmacy trend management, and clinical program development.
  • Experience with rebate strategy, manufacturer contracting concepts, and pharmacy financial management preferred.
  • Working knowledge of pharmacy operations, specialty pharmacy, and pharmacy benefit administration preferred.
  • Excellent communication, relationship management, presentation, and influencing skills.
  • Strong preference for candidates residing in or willing to relocate to the Raleigh-Durham area to support ongoing client engagement and partnership activities.

WhatYou'llGet

  • The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community
  • Work-life balance, flexibility, and the autonomy to dogreat work
  • Medical, dental, and vision coverage along withnumeroushealth and wellness programs
  • Parental leave and support plus adoption and surrogacyassistance
  • Career development programs and tuition reimbursement for continued education
  • 401k match including an annual company contribution
  • Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

Based on annual corporate goal achievement and individual performance.

$118,691.00 - $189,906.00

Skills

Clinical Knowledge, Clinical Pharmacy, Clinical Practice Management, Clinical Programs, Clinical Review, Clinical Trials Operations, Medicare, Medicare Part D, Medication Therapy Management, Nursing Practice, Patient Care Coordination, Pharmaceutical Medical Affairs, Pharmacy, Pharmacy Compliance, Pharmacy Management, Pharmacy Operations

_____________________________________________________________________
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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