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Utilization Review Coordinator Jobs in Raleigh, NC

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC · On-site

Reviews nursing documentation for accuracy, timeliness, and compliance. * Coordinates admissions ... Participates in quality improvement, utilization review, infection control, and risk management ...

New Hope

LEAD REGISTERED NURSE BUTNER NC

Butner, NC · On-site

Reviews nursing documentation for accuracy, timeliness, and compliance. * Coordinates admissions ... Participates in quality improvement, utilization review, infection control, and risk management ...

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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 19, 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.

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 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.

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 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 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 88% In-person, and 12% Remote job distribution, with an average salary of $59,862 per year, or $28.8 per hour.

LEAD REGISTERED NURSE BUTNER NC

New Hope

Butner, NC • On-site

Other

Posted 13 days ago

Job description

Since our opening in 1987, New Hope Treatment Centers has been a welcoming place for young people in moments of crisis. Our programs have played a role in countless success stories through our relational approach to behavioral healthcare.
The Lead Registered Nurse (Lead RN) provides clinical leadership and oversight of nursing services for adolescents receiving treatment in a secure, high-acuity behavioral health program operated in collaboration with the North Carolina Division of Juvenile Justice and Delinquency Prevention (DJJ). The Lead RN oversees nursing operations, supervises nursing staff, ensures compliance with nursing standards and regulatory requirements, and promotes safe, trauma-informed, evidence-based care. The Lead RN collaborates closely with the Program Director, PMHNP, therapists, case managers, and the interdisciplinary team to ensure continuity of care and clinical excellence.
Essential Duties and Responsibilities
  • Provides clinical leadership and supervision to Registered Nurses (RNs) and Certified Nursing Assistants (CNAs).
  • Oversees nursing assessments, care plans, medication administration, and physician orders.
  • Provides clinical consultation regarding complex medical, psychiatric, and behavioral presentations.
  • Collaborates with the PMHNP regarding medication management, laboratory monitoring, and clinical concerns.
  • Oversees medication storage, controlled substances, pharmacy coordination, and medication reconciliation.
  • Responds to psychiatric, behavioral, and medical emergencies while directing nursing response.
  • Reviews nursing documentation for accuracy, timeliness, and compliance.
  • Coordinates admissions, transfers, hospitalizations, specialty referrals, and discharge planning.
  • Participates in interdisciplinary treatment team meetings and discharge planning.
  • Ensures compliance with HIPAA, OSHA, DHSR, Medicaid, DJJ, Joint Commission, COA, and organizational standards.
  • Develops nursing schedules and assists with staffing coverage.
  • Conducts orientation, competency validation, coaching, and ongoing education for nursing staff.
  • Assists with recruitment, interviewing, onboarding, and retention of nursing staff.
  • Participates in quality improvement, utilization review, infection control, and risk management activities.
  • Reviews nursing incidents, medication variances, and quality indicators and implements corrective actions.
  • Collaborates with leadership during audits and regulatory reviews.
  • Promotes trauma-informed, youth-centered, culturally responsive nursing practice.
  • Performs other duties as assigned within the scope of nursing leadership.

Minimum Qualifications
  • BSN required; Master's degree preferred.
  • Current unrestricted North Carolina Registered Nurse license.
  • Current BLS/CPR certification.
  • Ability to pass required background checks and complete New Hope and DJJ training.
Preferred Qualifications
  • Three years of nursing experience in behavioral health, psychiatry, juvenile justice, residential treatment, emergency medicine, or child/adolescent services.
  • Previous nursing leadership experience.
  • Experience with electronic health records and trauma-informed care.
Required Knowledge, Skills, and Abilities
  • Advanced clinical assessment and critical thinking.
  • Strong leadership, coaching, and communication skills.
  • Knowledge of psychotropic medications and behavioral health diagnoses.
  • Knowledge of NC Nurse Practice Act, Medicaid, DJJ, DHSR, Joint Commission, and COA standards.
  • Ability to lead effectively in a fast-paced behavioral health environment.
Physical and Work Environment Requirements
  • Work performed in a secure behavioral health environment serving adolescents.
  • Ability to sit, stand, walk, bend, lift, and respond during emergencies.
  • Ability to safely respond to behavioral and medical crises.
  • May be exposed to behavioral crises, infectious diseases, and emotionally challenging situations.
  • Reasonable accommodations may be made for qualified individuals with disabilities.

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