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Utilization Review Coordinator Remote Jobs in Raleigh, NC

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...

IQVIA

Director, Remote Research Clinicians

Durham, NC · Remote

Review quality metrics, issue trends, audit findings, and operational performance indicators to ... Evaluate workload, utilization, productivity, quality, and customer satisfaction metrics. * Support ...

IQVIA

Clinical Research Coordinator

Raleigh, NC · Remote

$35 - $42/hr

Review source documentation and ensure timely resolution of data queries and discrepancies ... This position is not eligible for employment sponsorship. #LI-CES and #LI-DNP #LI-HCP #remote IQVIA ...

Red Oak Recovery Center

Clinical Director

Durham, NC · Remote

$90K - $100K/yr

Participate in utilization review meetings, representing patient needs in both clinical and ... coordinated care * Stay current with emerging trends in addiction treatment and integrate new ...

Accounting Fly

Remote Tax Manager

Wake Forest, NC · On-site +1

$110K - $140K/yr

Review and prepare individual, business, fiduciary, and related tax returns * Serve as a trusted ... Experience coordinating workflows or leading a team * Familiarity with UltraTax CS, QuickBooks ...

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All JobsUtilization Review JobsUtilization Review Coordinator Remote JobsUtilization Review Coordinator Remote Jobs in Raleigh, NC

Utilization Review Coordinator Remote information

See Raleigh, NC salary details

$15

$28

$45

How much do utilization review coordinator remote jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization review coordinator remote in Raleigh, NC is $28.78, according to ZipRecruiter salary data. Most workers in this role earn between $20.82 and $33.65 per hour, depending on experience, location, and employer.

What does a utilization review coordinator do when working remotely?

A Utilization Review Coordinator working remotely is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and procedures. They review medical records, treatment plans, and insurance policies to ensure compliance with regulations and that patients receive proper care without unnecessary costs. Remote UR Coordinators collaborate with healthcare providers, payers, and patients primarily through electronic records and virtual communication, maintaining strong organizational and analytical skills. Their goal is to optimize patient outcomes while managing healthcare resources effectively.

What are the key skills and qualifications needed to thrive as a utilization review coordinator remote?

To thrive as a Utilization Review Coordinator Remote, you need a strong background in healthcare, knowledge of medical terminology, and often an active RN or LPN license. Familiarity with utilization management software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is typically required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating medical necessity and collaborating with providers. These skills ensure accurate, efficient case reviews and compliance with regulations, which are vital for optimizing patient care and managing healthcare costs.

How does a utilization review coordinator typically collaborate with healthcare providers and insurance companies?

As a remote Utilization Review Coordinator, you will regularly communicate with healthcare providers and insurance representatives via phone, email, and secure digital platforms. Your main responsibilities include reviewing patient records, making coverage determinations, and ensuring compliance with regulatory guidelines. Collaboration often involves clarifying medical necessity, gathering additional documentation, and participating in virtual team meetings to discuss complex cases. Strong communication skills and comfort with digital tools are essential for seamless coordination across remote teams.
What are popular job titles related to Utilization Review Coordinator Remote jobs in Raleigh, NC? For Utilization Review Coordinator Remote jobs in Raleigh, NC, the most frequently searched job titles are:
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What cities near Raleigh, NC are hiring for Utilization Review Coordinator Remote jobs? Cities near Raleigh, NC with the most Utilization Review Coordinator Remote job openings:
Utilization Review Coordinator Remote jobs near you
Infographic showing various Utilization Review Coordinator Remote job openings in Raleigh, NC as of August 2026, with employment types broken down into 81% Full Time, and 19% Part Time. Highlights an 33% In-person, and 67% Remote job distribution, with an average salary of $59,865 per year, or $28.8 per hour.

NCQA Quality & Accreditation Specialist (Full Time, Remote, North Carolina Based)

Alliance

Morrisville, NC • On-site, Remote

$69K - $88K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

The NCQA Quality & Accreditation Specialist serves as the project management lead and subject matter expert for assigned NCQA standard areas and manages the assessment of related business functions for corresponding departments within the scope of NCQA standards (e.g. Provider and Member Services, Utilization Management, Population Health, Care Management, Provider Network, Member and Provider Communications, Delegation Oversight) to support high-quality performance and ensure successful NCQA Accreditation process.
This position is fulltime remote. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed.
Responsibilities & Duties
Implement and Monitor Accreditation Workplan
  • Project management lead for assigned NCQA standard categories within the organization's QI workplan to achieve and maintain Health Plan Accreditation with LTSS distinction and any additional accreditations Alliance Health pursues
  • Identify gaps and risks and provide regular status reports from NCQA tracker to leadership
  • Serve as lead for NCQA Accreditation reviews for assigned standard categories by gathering all necessary documents and information from business areas, managing timely document submissions to NCQA, facilitating NCQA requests for additional information, and coordinating onsite review activities
  • Review and update policies and procedures, reports, materials, and files for completeness, accuracy, and compliance with NCQA Standards
  • Maintain calendar of documentation due dates, ongoing collection and tagging relevant policies/procedures, reports, materials, and files as appropriate
  • Participate in Delegation Oversight and audits as appropriate

Drive Organizational Accreditation Efforts
  • Provide technical support and education to staff regarding NCQA Health Plan Accreditation and LTSS Distinction Standards and supporting documentation
  • Assess business area functions against current and upcoming NCQA standards and identify potential performance gaps and associated risks and update NCQA tracker upon release of new/updated standards
  • Serve as the accreditation subject matter expert within organizational wide, cross-functional, and multi-disciplinary teams to bring each business area to a state of readiness
  • Identify and facilitate business area process improvements via means such as policies, workflows, and processes; follow-up to ensure improved outcomes
  • Coordinate and collaborate with cross-departmental teams to identify and implement organization-wide strategic initiatives that support quality performance
  • Communicate reporting due dates and reminders to business leads and leadership as appropriate
  • Maintain clear status updates regarding NCQA Readiness on NCQA Tracker, communicating risks as appropriate

Minimum Requirements
Education & Experience
Required:
Bachelor's degree in Healthcare, Human Services, Public Health Administration, Nursing, Business, or related field and three (3) years of project management experience in a managed care or healthcare setting with knowledge and practical experience health care quality or NCQA Health Plan accreditation processes and requirements.
Preferred:
Experience with NCQA Accreditation standards.
Knowledge of regulatory reporting, compliance requirements, and auditing procedures.
Project management.
Knowledge, Skills, & Abilities
  • Knowledge of NCQA accreditation processes and standards
  • Knowledge and understanding of federal and state regulations
  • Planning, project management and organizational skills
  • Excellent communication skills (written and verbal).
  • Interpersonal skills which are effective, respectful, and sensitive to a diverse and multicultural population of children, families, and co-workers,
  • Problem-solving, mediation, and conflict resolution skills
  • Teamwork and collaboration skills
  • Microsoft Project, Excel, Word (Edits and Tracking), and PowerPoint skills
  • Facilitation skills
  • Ability to work in a fast-paced environment with frequent interruptions
  • Ability to work under minimal supervision

Salary Range
$69,592 - $88,729/ Annual
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
    • Medical, Dental, Vision, Life, Long Term Disability
    • Generous retirement savings plan
    • Flexible work schedules including hybrid/remote options
    • Paid time off including vacation, sick leave, holiday, management leave
    • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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