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Utilization Management Jobs in Raleigh, 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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Utilization Management information

See Raleigh, NC salary details

$37.9K

$87K

$158.4K

How much do utilization management jobs pay per year?

As of Jul 21, 2026, the average yearly pay for utilization management in Raleigh, NC is $86,979.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,700.00 and $101,600.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 is a Utilization Management job?

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 most commonly searched types of Utilization Management jobs in Raleigh, NC? The most popular types of Utilization Management jobs in Raleigh, NC are:
What are popular job titles related to Utilization Management jobs in Raleigh, NC? For Utilization Management jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Raleigh, NC look for? The top searched job categories for Utilization Management jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Management jobs? Cities near Raleigh, NC with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Raleigh, NC as of July 2026, with employment types broken down into 91% Full Time, and 9% Contract. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $86,979 per year, or $41.8 per hour.
Health - Network Performance / Utilization Manager

Health - Network Performance / Utilization Manager

Accenture

Raleigh, NC

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Accenture Federal Services rating

8.4

Company rating: 8.4 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

50th of 451 rated business services

Job description

Accenture is a leading global professional services company that helps the world's leading businesses, governments and other organizations build their digital core,optimizetheir operations, accelerate revenuegrowthand enhance citizen services-creating tangible value at speed and scale. We are a talent- andinnovation-led company with approximately750,000 peopleserving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world's leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functionalexpertiseand global delivery capability. We are uniquely able to deliver tangible outcomes because of our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song. These capabilities, together with our culture of shared success and commitment to creating 360 value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360 value we create for our clients, each other, our shareholders,partnersand communities. Visit us atwww.accenture.com.

Strategy & Consulting:We work with C-suite executives, leaders and boards of the world's leading organizations, helping them reinvent every part of their enterprise to drive greater growth, enhance competitiveness, implement operational improvements, reduce cost, deliver sustainable 360 stakeholder value, and set a new performance frontier for themselves and the industry in which they operate. Our deep industry and functionalexpertiseissupported by proprietary assets and solutions that help organizations transform faster and become more resilient. Underpinned by technology, data, analytics, AI, change management, talent and sustainability capabilities, our Strategy & Consulting services help architect and accelerate all aspects of an organization's total enterprise reinvention.

Role Summary
Advise clients on network strategy,utilizationperformance, and provider market challenges across Medicaid, rural, and financially pressured environments. The successful candidate will combine deep domainexpertisewith strong consulting judgment and will be expected to manage teams, advise senior clients, and deliver complex engagements in network strategy,utilization, and provider performance. This individual will build trusted client relationships and help clients improve network performance, access, and provider sustainability in line with their strategic priorities.

As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include:

  • Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market performance.

  • Advise clients on evaluating leakage, referral patterns, service distribution, network adequacy, and provider sustainability.

  • Develop strategic recommendations to improve network design, access,utilizationmanagement, provider alignment, and value-based outcomes.

  • Translate claims,encounter,provider, and market data into clear insights, strategic options, and executive decision materials.

  • Manage day-to-day engagement delivery, including workplans, team coordination, deliverable quality, and client communications.

  • Work across reimbursement, analytics, policy, and provider strategy teams to solve complex market and performance challenges.

  • Build trusted relationships with client stakeholders and help grow the practice's network performance andutilizationwork.

  • Travel: As required, up to 80%

Why should I join the Accenture Health team?

  • Innovate every day.Be at the forefront of designing and delivering health technology solutions that push boundaries and create new opportunities for our clients.

  • Lead with the industry's best. Join an industry-recognized healthcare leader with more than 20,000 global healthcare professionals collaborating to drive enterprise-wide transformational projects on a global scale. Accenture has worked with more than 200 clients to deliver healthcaretransformationto meet the diverse needs of patients and members.

  • Learn and grow continuously.Harness unmatched training and professional development to help you build and advance your health, consultative and delivery skills. With learning resources, interactive classroom courses, real-life clientsimulationsand ongoing mentoring available when you need it,you'llexpand your thinking beyond the core Workday implementation.

Qualification

Here'swhat you need:

  • Minimum of 5 years of experience in network strategy,utilizationanalytics, provider economics, or healthcare market analysis.

  • Minimum of 2 years of experience assessing hospitals, rural providers, FQHCs, specialty providers, and community-based providers in Medicaid-heavy or financially distressed environments.

  • Minimum of 2 years of experience turning claims,encounter,provider, and market data into strategic recommendations.

  • Bachelor's Degree

Bonus points if you have:

  • Familiarity with provider directory and network data management, data quality, and encounter completeness.

  • Strong understanding of provider capacity, leakage, referral patterns,utilizationdrivers, access, and network adequacy.

  • Ability to connectutilizationperformance to reimbursement, provider sustainability, and VBC outcomes.

  • Experience building provider performance scorecards (utilization, quality, access, equity,financial impact).

  • Understanding ofservice line strategy and site-of-care optimization (ASC vs HOPD, home-based care, telehealth).

Compensation at Accenture varies depending on a wide array of factors, which may include but are not limited to the specific office location, role, skill set, and level of experience. As required by local law, Accenture provides a reasonable range of compensation for roles that may be hired as set forth below.
We anticipate this job posting will be posted until 06/18/2026.

Accenture offers a market competitive suite of benefits including medical, dental, vision, life, and long-term disability coverage, a 401(k) plan, bonus opportunities, paid holidays, and paid time off. See more information on our benefits here:

U.S. Employee Benefits | Accenture

Role Location Annual Salary Range

California $94,400 to $293,800

Cleveland $87,400 to $235,000

Colorado $94,400 to $253,800

District of Columbia $100,500 to $270,300

Illinois $87,400 to $253,800

Maine $80,400 to $216,200

Maryland $94,400 to $253,800

Massachusetts $94,400 to $270,300

Minnesota $94,400 to $253,800

New York $87,400 to $293,800

New Jersey $100,500 to $293,800

Virginia $87,400 to $270,300

Washington $100,500 to $270,300

About Accenture

Accenture is a leading global professional services company that helps the world's leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services-creating tangible value at speed and scale. We are a talent- and innovation-led company with approximately 791,000 people serving clients in more than 120 countries. Technology is at the core of change today, and we are one of the world's leaders in helping drive that change, with strong ecosystem relationships. We combine our strength in technology and leadership in cloud, data and AI with unmatched industry experience, functional expertise and global delivery capability. Our broad range of services, solutions and assets across Strategy & Consulting, Technology, Operations, Industry X and Song, together with our culture of shared success and commitment to creating 360 value, enable us to help our clients reinvent and build trusted, lasting relationships. We measure our success by the 360 value we create for our clients, each other, our shareholders, partners and communities.

Visit us atwww.accenture.com

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities.Read more here

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs such as for a disability or religious observance, please call us toll free at 1 (877) 889-9009 or send us anemailor speak with your recruiter.

Equal Employment Opportunity Statement

We believe that no one should be discriminated against because of their differences.All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, military veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by applicable law.Our rich diversity makes us more innovative, more competitive, and more creative, which helps us better serve our clients and our communities.

For details, view a copy of the Accenture Equal Opportunity Statement

Accenture is an EEO and Affirmative Action Employer of Veterans/Individuals with Disabilities.

Accenture is committed to providing veteran employment opportunities to our service men and women.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process. Further, at Accenture a criminal conviction history is not an absolute bar to employment.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

California requires additional notifications for applicants and employees. If you are a California resident, live in or plan to work from Los Angeles County upon being hired for this position, pleaseclick herefor additional important information.

Please read Accenture'sRecruiting and Hiring Statementfor more information on how we process your data during the Recruiting and Hiring process.

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