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Utilization Review Coordinator Jobs in Raleigh, NC

Duke Health

Utilization Manager

Durham, NC · On-site

Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Maintains effective communication with health care team members related to care coordination and ...

Duke University

Utilization Manager

Durham, NC · On-site

Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Maintains effective communication with health care team members related to care coordination and ...

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Utilization Review Coordinator information

See Raleigh, NC salary details

$15

$28

$45

How much do utilization review coordinator jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization review coordinator 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.

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

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What degree do I need for utilization review coordinator?

A utilization review coordinator typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and healthcare regulations is also important.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What skills and qualifications are needed to be a utilization review coordinator?

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

What are the most commonly searched types of Utilization Review jobs in Raleigh, NC?

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

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

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

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

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

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

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

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Raleigh, NC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $59,862 per year, or $28.8 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Other

Re-posted 25 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

Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.

What Granville Health System employees say

Pay

Hours and flexibility

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