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Utilization Manager Jobs in Raleigh, 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 Raleigh, NC

Utilization Manager information

See Raleigh, NC salary details

$37.9K

$88.5K

$162.8K

How much do utilization manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization manager in Raleigh, NC is $88,465.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,800.00 and $106,400.00 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 the most commonly searched types of Utilization jobs in Raleigh, NC?

The most popular types of Utilization jobs in Raleigh, NC are:

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

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

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

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

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

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

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Raleigh, NC as of August 2026, with employment types broken down into 86% Full Time, 12% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $88,470 per year, or $42.5 per hour.

Case Manager - Utilization Review

Granville Health System

Oxford, NC • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 16 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Case Manager - Utilization Review
Location: Granville Health System, Oxford NC

About Granville Health System:

For over a century, Granville Health System has been at the forefront of quality healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.

About Oxford, NC

Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters—perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.

Position Overview:
The primary role of the Case Manager is to review and monitor members’ utilization of health care services with the goal of maintaining high quality, cost-effective care. This role will provide the medical and utilization review expertise necessary to evaluate patient status.  This includes reviewing clinical information against established criteria, assessing the medical necessity of services and procedures, collaborating with providers and interdisciplinary teams, and ensuring that the patient is placed at the appropriate level of care from the time of admission. This includes providing referral authorization, concurrent review, proactive discharge/transition planning, appropriate referral to case management, and high-dollar claims review.

Position Highlights:

  • Retirement Benefits: NC Local Government Pension Plan (5-year vesting period)
  • Loan Forgiveness: Eligible employer for Public Service Loan Forgiveness (PSLF)
  • Comprehensive Benefits: Medical, dental, vision, life insurance, and various supplemental benefits available

Key Responsibilities:

• Conduct concurrent review of all patients, regardless of payer source, using approved screening criteria

• Perform admission reviews on the first working day following admission

• Conduct continued stay reviews at least every three (3) days or more frequently as indicated

Qualifications

Associate degree in a healthcare-related field or equivalent combination of healthcare experience and education.                                                                    

At least a year of experience in a related role (utilization review, case management, care coordination, insurance authorization/prior authorization, clinical documentation review, hospital patient access or revenue cycle support, healthcare quality or compliance functions).

Strong attention to detail, organizational skills and interpersonal skills.  Ability to interpret clinical documentation and apply review criteria.  Strong communication skills for interaction with physicians and interdisciplinary teams.  Knowledge of healthcare regulations and payer requirements

Preferred

Bachelor’s degree in Health Administration, Public Health, Social Work, Healthcare Management, or related field. Accredited Case Manager (ACM) certification. 

Experience with insurance authorization criteria preferred; one year utilization and discharge planning experience.

Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.

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