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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 ...

Senture

Medical Director

Raleigh, NC · Remote

This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...

Senture

Medical Director

Raleigh, NC · On-site

This position will support as a consulting Medical Director role supporting a Credentialing Verification Organization (CVO), health plan, or utilization management operation The Medical Director ...

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All JobsUtilization Management JobsUtilization Management Jobs in Raleigh, NC

Utilization Management information

See Raleigh, NC salary details

$37.9K

$87K

$158.4K

How much do utilization management jobs pay per year?

As of Sep 3, 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 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 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 August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, 4% Hybrid, and 16% Remote job distribution, with an average salary of $86,979 per year, or $41.8 per hour.

Behavioral Health Case Manager

Duke University

Durham, NC • On-site

Full-time

Re-posted 17 days ago

Duke University rating

6.7

Company rating: 6.7 out of 10

Based on 55 frontline employees who took The Breakroom Quiz

491st of 628 rated colleges and universities

Job description

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About Duke Regional Hospital
Pursue your passion for caring with Duke Regional Hospital in Durham, North Carolina. With 388 beds it is the second largest of Duke Health's four hospitals and offers a comprehensive range ofmedical, surgical, and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services.
Manage a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions across the continuum of care. Ensure optimum utilization of the patient's and the Health System's resources and perform these duties within the requirements of CMS and other external review agencies.
Work Performed
  • Monitor daily census and assignment to assure all patients are assessed for case management needs including care coordination/transition and discharge planning, consultations, advocacy, education.
  • Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
  • Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations. Provide education and guidance on these topics to providers, patients and families as needed.
  • 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, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required. Monitor daily census and assignment to assure all patients are assessed for case management needs including care coordination/transition and discharge planning, consultations, advocacy, education.
  • Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
  • Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations. Provide education and guidance on these topics to providers, patients and families as needed.
  • 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, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required.
  • Inpatient Job Responsibilities/Activities
  • Complete initial assessment within 72 hours to identify psychosocial strengths, weaknesses, community living supports present and needed.
  • Contact with patient primary support systems to gather information regarding dynamics and needs of support system.
  • Conduct support system/family therapy to allow patient/support to practice skills needed to support community living and/or assist in development of functional patterns of interactions.
  • Conduct group sessions for patients focused on skill building/interactional skills.
  • Assist patient in development of safety plan to promote positive coping while living in community setting.
  • Facilitate discharge planning for patients, involving support systems when possible, to provide level of intervention that creates environment for crisis contacts and safe community living.
  • Interface with team to determine multidisciplinary assessment of discharge planning needs and provide information regarding support system/family function.
  • Update Interqual.
  • Other duties as assigned.
  • Typical case load is 10 patients.

Knowledge, Skills and Abilities
  • 3 yrs. Adult/Mental health experience preferred
  • Ability to work effectively in a self-directed role
  • Ability to multi-task
  • LCSW-A or LCSW
  • capable of daily problem-solving complex issues
  • Excellent written and verbal skills
  • Basic computer skills necessary

Lev el Characteristics
N/A
Minimum Qualifications
Education
Master's degree in social work from an accredited school of social work.
Experience
3 years of relevant experience.
Degrees, Licensures, Certifications
Current licensure as a licensed clinical social worker (LCSW) by the NC Social Work Certification and Licensure Board. Consult/Liason should also be a Notary.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions:
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

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About Duke University

Sourced by ZipRecruiter

Duke is regarded as one of America's leading research universities. Located in Durham, North Carolina, Duke is positioned in the heart of the Research Triangle, which is ranked annually as one of the best places in the country to work and live. Duke has more than 15,000 students who study and conduct research in its 10 undergraduate, graduate, and professional schools. With about 40,000 employees, Duke is the third largest private employer in North Carolina, and it now has international programs in more than 150 countries.

Industry

Colleges, universities, and professional schools and hospitals

Company size

10,000+ Employees

Headquarters location

Durham, NC, US

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