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Utilization Manager Jobs in Raleigh, NC (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Raleigh, NC · On-site +1

$51 - $62.25/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

Dukehealth.org

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke Health

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke University

Case Manager

Durham, NC · On-site

$19.25 - $24.75/hr

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke Health

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

Duke University

Case Manager

Durham, NC

$19.25 - $24.75/hr

This role supports optimal patient outcomes, effective resource utilization, and compliance with CMS and other regulatory agencies. The Case Manager collaborates closely with interdisciplinary teams ...

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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 May 30, 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, 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 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 does a Utilization Manager do?

A Utilization Manager is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their primary goal is to ensure that patients receive the right care at the right time while also controlling costs for hospitals, insurance companies, or healthcare organizations. Utilization Managers review patient records, coordinate with healthcare providers, and use clinical guidelines to make informed decisions about treatment approvals or denials. They play a key role in maintaining quality care and regulatory compliance.

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 May 2026, with employment types broken down into 76% Full Time, 20% Part Time, 1% Temporary, and 3% Contract. Highlights an 98% Physical, and 2% Hybrid job distribution, with an average salary of $88,465 per year, or $42.5 per hour.
Travel RN Care Manager

Travel RN Care Manager

American Traveler

Chapel Hill, NC

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 3 days ago

Job description

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Chapel Hill, North Carolina.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 06/22/2026
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 3x12hrs
  • Hours: 36 hrs/wk
  • Start Date: Jun 22, 2026
  • Length: 13 weeks
  • Openings: 3
Description

American Traveler is hiring a travel RN - Care Manager for an acute care hospital case management role requiring Epic experience and at least 2 years of RN experience in an acute care setting.

Details
  • Day shift position, 8:00am - 5:00pm, 3x12-hour shifts per week (36 hours/week)
  • Hospital-based Care Management unit within a large academic medical center
  • Patient population is acutely ill with complex medical needs across multiple service lines including Cardiology, Nephrology, Trauma Surgery, Orthopedic Surgery, Vascular Surgery, Neurosurgery, GI Surgery, Urology, Transplant, and ICU/Step-down
  • Caseload covers approximately 20-25 beds across assigned units
  • Epic EMR used for all care plan documentation
  • No on-call, weekend, or holiday requirements
Requirements
  • Active RN license in NC or a compact state license is required
  • Minimum 2 years of RN experience in an acute care hospital setting required
  • Prior experience as a case/care manager or discharge planner in a hospital setting required
  • Nursing Diploma or ADN/ASN from an accredited nursing program required; BSN or MSN preferred
  • Experience with Epic EMR required
  • Strong assessment, critical thinking, care planning, documentation, and problem-solving skills required
  • Two professional references required for consideration
  • Experience in an academic or teaching hospital setting strongly preferred
Additional Information
  • Responsibilities include comprehensive patient assessment, care planning, utilization review, and discharge planning for acutely ill patients with complex needs
  • Participates in daily Care Management Touchpoint meetings and weekly Complex Care Meetings (CCM) to review patient progression and problem-solve complex cases
  • Collaborates with an interdisciplinary team including Social Workers, Utilization Managers, and Care Management Assistants
  • Identifies barriers to discharge, coordinates family meetings, and manages transitions of care including post-acute service referrals
  • Monitors observation patients throughout the day to ensure appropriate progression and discharge readiness
  • Provides education on community resources and coordinates referrals to post-acute providers as needed
  • Experience working alongside interdisciplinary teams in an academic/teaching hospital environment is highly valued

American Traveler Job ID #P-712436. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

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