One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical ...
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical ...
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 ...
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 ...
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 ...
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 ...
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
... reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care Coordination and case ...
... reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care Coordination and case ...
... reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care Coordination and case ...
... reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care Coordination and case ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...
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 ...
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 ...
Utilization Review Coordinator information
See Raleigh, NC salary details
$14.14 - $16.64
7% of jobs
$18.92 is the 25th percentile. Wages below this are outliers.
$16.64 - $19.13
19% of jobs
$19.13 - $21.62
22% of jobs
The median wage is $21.87 / hr.
$21.62 - $24.12
11% of jobs
$24.12 - $26.61
4% of jobs
$26.61 - $29.10
5% of jobs
$30.16 is the 75th percentile. Wages above this are outliers.
$29.10 - $31.60
14% of jobs
$31.60 - $34.09
10% of jobs
$34.09 - $36.58
4% of jobs
$36.58 - $39.08
2% of jobs
$39.08 - $41.57
1% of jobs
$14
$26
$41
How much do utilization review coordinator jobs pay per hour?
As of Aug 6, 2026, the average hourly pay for utilization review coordinator in Raleigh, NC is $26.39, according to ZipRecruiter salary data. Most workers in this role earn between $19.09 and $30.87 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?
| Aspect | Utilization Review Coordinator | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a healthcare-related certification or associate degree | Registered Nurse (RN) license required |
| Work Environment | Office setting, administrative tasks, coordination | Clinical setting, patient chart review, direct communication with healthcare providers |
| Employer & Industry | Insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare providers |
| Common Search & Comparison | Focuses on administrative review processes | Involves 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:
- Behavioral Health Utilization Review
- Utilization Management
- Cvs Health Utilization Management
- Evening Optum Health Utilization Review
- Utilization Review Physician
- Manager Utilization Management
- Navihealth Clinical Review Coordinator
- Senior Behavioral Health Utilization Review
- Full Time Behavioral Health Utilization Review
- Per Diem Utilization Review Nurse
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:
- Nurse Practitioner Utilization Review
- Remote Dental Utilization Review
- Utilization Review
- Remote Occupational Therapy Utilization Review
- Chart Utilization Review
- Full Time Cigna Utilization Review
- Utilization Review Salary
- Registered Nurse Case Review
- Full Time Navihealth Utilization Review
- Internship Remote Utilization Review
What cities near Raleigh, NC are hiring for Utilization Review Coordinator jobs? Cities near Raleigh, NC with the most Utilization Review Coordinator job openings:
Granville Health System rating
8.6
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
Workplace
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