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Utilization Review No Experience Jobs in Raleigh, NC

Duke University

Utilization Manager

Durham, NC · On-site

No matter where your talents lie, join us and discover how we can advance health together. About ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

No matter where your talents lie, join us and discover how we can advance health together. About ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

No matter where your talents lie, join us and discover how we can advance health together. About ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke University

Utilization Manager

Durham, NC · On-site

No matter where your talents lie, join us and discover how we can advance health together. About ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

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All JobsUtilization Review JobsUtilization Review No Experience JobsUtilization Review No Experience Jobs in Raleigh, NC

Utilization Review No Experience information

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$20

$41

$67

How much do utilization review no experience jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization review no experience in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

What is the difference between Utilization Review No Experience vs Utilization Review Coordinator?

AspectUtilization Review No ExperienceUtilization Review Coordinator
Required CredentialsHigh school diploma or equivalent; on-the-job trainingHigh school diploma; certification may be preferred
Work EnvironmentEntry-level, training-focused, healthcare settingsOffice-based, healthcare facilities, insurance companies
Employer & Industry UsageHospitals, insurance companies, healthcare providersInsurance companies, healthcare organizations, managed care
Search & Comparison IntentEntry-level, no experience, trainingCoordination, case management, healthcare review

Utilization Review No Experience roles are entry-level positions requiring minimal credentials and focus on training within healthcare settings. In contrast, Utilization Review Coordinators typically have some experience or certification, handling case management and review tasks in healthcare or insurance environments. Both roles are essential in healthcare utilization management but differ mainly in experience requirements and responsibilities.

What is utilization review?

Utilization review is a process used in healthcare to assess the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. Many entry-level utilization review positions are available for individuals with clinical backgrounds, such as nurses or social workers, even if they do not have prior experience in utilization review specifically. Employers often provide on-the-job training for candidates who understand medical terminology and have a background in healthcare. If you do not have a clinical license, you may need to seek administrative or support roles in utilization review to gain experience.

What are the key skills and qualifications needed to thrive as a utilization review specialist with no prior experience?

To thrive as a Utilization Review Specialist without prior experience, you generally need a healthcare-related degree, strong analytical skills, and a good understanding of medical terminology. Familiarity with case management software, electronic health records (EHR), and UR-specific platforms is typically required, and some roles may prefer candidates to pursue certification like Certified Utilization Review Specialist (CURA) over time. Attention to detail, effective communication, and strong organizational skills help new professionals excel in assessing medical necessity and collaborating with healthcare teams. These competencies ensure accurate reviews, regulatory compliance, and positive patient outcomes in a complex healthcare environment.

What are common challenges faced by entry-level professionals in utilization review and how can they be addressed?

Entry-level professionals in Utilization Review often face challenges such as learning complex medical terminology, understanding insurance regulations, and adapting to fast-paced review processes. To overcome these, it's helpful to seek mentorship from experienced team members, utilize available training resources, and stay organized with case management tools. Regular communication with clinical staff and supervisors also helps clarify protocols and expectations, making it easier to build confidence and competence in the role.
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 No Experience jobs in Raleigh, NC? For Utilization Review No Experience jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Utilization Review No Experience jobs in Raleigh, NC look for? The top searched job categories for Utilization Review No Experience jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Review No Experience jobs? Cities near Raleigh, NC with the most Utilization Review No Experience job openings:
Utilization Review No Experience jobs near you
Infographic showing various Utilization Review No Experience job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Other

Re-posted 20 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.

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