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Utilization Manager Jobs in Durham, NC (NOW HIRING)

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Manage a designated caseload to coordinate and complete timely assessment, planning, implementation ... Ensure optimum utilization of the patient's and the Health System's resources and perform these ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Manage a designated caseload to coordinate and complete timely assessment, planning, implementation ... Ensure optimum utilization of the patient's and the Health System's resources and perform these ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Durham, NC

Utilization Manager information

See Durham, NC salary details

$37.7K

$87.9K

$161.9K

How much do utilization manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization manager in Durham, NC is $87,945.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,500.00 and $105,800.00 per year, depending on experience, location, and employer.

What is a utilization manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

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

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs

What are popular job titles related to Utilization Manager jobs in Durham, NC?

For Utilization Manager jobs in Durham, NC, the most frequently searched job titles are:

What job categories do people searching Utilization Manager jobs in Durham, NC look for?

The top searched job categories for Utilization Manager jobs in Durham, NC are:

What cities near Durham, NC are hiring for Utilization Manager jobs?

Cities near Durham, NC with the most Utilization Manager job openings:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Durham, NC as of August 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Contract. Highlights an 83% In-person, 3% Hybrid, and 14% Remote job distribution, with an average salary of $87,945 per year, or $42.3 per hour.

Utilization Review Specialist

Memorial Physician Practices

Raleigh, NC • On-site

$60 - $85/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Job description

Your experience matters

Lifepoint Behavioral Health is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. Triangle Springs is a 77-bed behavioral health hospital located in Raleigh, North Carolina, providing care for patients with mental health and substance use disorders. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Registered Nurse (RN) joining our team, you're embracing a vital mission dedicated to making communities healthier®. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning.

Job Responsibilities
  • Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
  • Complete pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
  • Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
  • Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
  • Works with DON to ensure documentation requirements are met.
  • Ensure appeals are completed thoroughly and on a timely basis.
  • Interface with managed care organizations, external reviews, and other payers.
  • Communicate with physicians to schedule peer-to-peer reviews.
What we're looking for
  • Education: Bachelor's degree required. Master's degree preferred.
  • Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
  • License: Current unencumbered clinical license strongly preferred.
  • Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred.
Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

  • Comprehensive Benefits: Multiple levels of medical, dental, and vision coverage for full-time and part-time employees
  • Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave, and paid time off
  • Financial & Career Growth: Tuition reimbursement and 401(k) retirement package with company match
  • Employee Well-being: Mental, physical, and financial wellness programs, including Employee Assistance Program and discount programs
  • Professional Development: Ongoing learning and career advancement opportunities
  • Additional Perks: Shift differentials and set schedules
EEOC Statement

Lifepoint Behavioral Health is an Equal Opportunity Employer. Lifepoint Behavioral Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

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