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Utilization Manager Jobs in Raleigh, NC (NOW HIRING)

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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 Jul 22, 2026, the average yearly pay for utilization manager in Raleigh, NC is $88,470.00, 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 does a utilization manager do?

A utilization manager oversees the allocation and efficient use of resources, such as staff and equipment, to meet organizational goals. They analyze data, monitor utilization rates, and ensure compliance with policies, often using tools like spreadsheets or specialized software. This role requires strong organizational and communication skills to optimize productivity and control costs.

What jobs pay 4000 a week without a degree?

Utilization Managers typically require a relevant background in healthcare, logistics, or operations, and their salaries usually do not reach $4,000 weekly without specialized experience or certifications. High-paying roles that can reach this level without a degree often include sales, real estate, or skilled trades like certain construction or technical jobs, which rely more on experience and skills than formal education.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

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 is the highest paying job in healthcare management?

The highest paying roles in healthcare management include Chief Executive Officers (CEOs) of hospitals and health systems, with salaries often exceeding $200,000 annually. Other high-paying positions include Chief Financial Officers (CFOs) and Chief Operating Officers (COOs), who oversee organizational strategy and operations, typically earning six-figure salaries. These roles require extensive experience, advanced degrees, and strong leadership skills.

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 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 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.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative skills and knowledge of medical terminology. It provides experience in patient interaction, scheduling, and office management, which can serve as a stepping stone to more advanced healthcare roles. However, career advancement may require additional certifications or education.
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 July 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $88,470 per year, or $42.5 per hour.
Behavioral Health Case Manager 7p to 7a

Behavioral Health Case Manager 7p to 7a

Duke Health

Durham, NC • On-site

Full-time

Posted 3 days ago

Duke Health rating

7.3

Company rating: 7.3 out of 10

Based on 250 frontline employees who took The Breakroom Quiz

305th of 888 rated healthcare providers

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 University Hospital
Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.
JOB OVERVIEW
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.
Duties and Responsibilities
  • 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.

Consult/Liason Job Responsibilities/Activities
  • Primary responsibility is to complete assessments in ED and discharge planning for patients within the hospitals.
  • Secondary responsibility is discharge planning assistance for psychiatric followup for patients being treated for a medical condition.
  • Complete crisis assessments to determine level of care required for patient to move to safe community living including but not limited to reason for presentation, current symptoms and level of distress, ability to participate in treatment, safety assessment, past history of treatment, current support systems, strengths, weaknesses and primary psychiatric diagnosis.
  • Facilitate discharge planning with psychiatric appointments or referrals to other facilities as determined by level of care needed.
  • Facilitate tracking of IVC paperwork for all patients who are awaiting transfer to another facility.
  • Interface with team for cases covered by consult service to determine multidisciplinary assessment of discharge planning needs and provide information regarding support system/family function.
  • Update Interqual for patients who are not being treated for a medical condition (typically observation patients at Duke Raleigh).
  • Case load varies as immediate needs vary. As a guide, 3 initial assessments and discharge planning activities for up to 6 patients could be completed during 8 hour shift. Pediatric cases take longer to complete initial assessment so the total number would be reduced if a patient is under 18.
  • Provide community liaison to one mental health workgroup.

Minimum Qualifications
Education
Master's degree in social work from an accredited school of social work.
Experience
3 years of relevant experience.
Degrees, Licensure, and/or Certification
  • 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.

Knowledge, Skills, and Abilities
  • Ability to work effectively in a self-directed role
  • Ability to multi-task, capable of daily problem-solving complex issues Excellent written and verbal skills
  • Basic computer skills necessary

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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