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Utilization Review Nurse Jobs in Raleigh, NC (NOW HIRING)

UNC HEALTH

RN Care Manager - Care Management

Smithfield, NC · On-site

$35.87 - $51.57/hr

... utilization review and discharge planning. The Care Manager must be highly organized professional with great attention to detail, adaptable to frequent change, and compliant with regulatory and ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... utilization review encouraged C. Licensure/Certification 1. Current registration to practice as a Registered Nurse in the the applicable state as determined by job location 2. Case Management ...

Advocate Aurora Health

Case Manager SE

Wake Forest, NC · On-site

$38.20 - $57.30/hr

... utilization review encouraged C. Licensure/Certification 1. Current registration to practice as a Registered Nurse in the the applicable state as determined by job location 2. Case Management ...

Advocate Aurora Health

Case Manager NEX

Wake Forest, NC · On-site

$38.20 - $57.30/hr

Graduate from an accredited school of nursing. BSN required. MSN preferred. Minimum 5 years of ... Utilization Review staff of necessary changes 9. Utilizes principles of quality improvement in ...

Professional Healthcare LLC

Case Manager

Raleigh, NC · On-site

$60 - $80/hr

Participate in clinical record/utilization review of medical records and quality assurance and ... Immediately report to Nursing Supervisor any patient incidents, variances, or complaints.

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Showing results 21-40

All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Raleigh, NC

Utilization Review Nurse information

See Raleigh, NC salary details

$20

$41

$67

How much do utilization review nurse jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review nurse 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 does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

More about Utilization Review Nurse jobs

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

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

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

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

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

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

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

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

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Raleigh, NC as of August 2026, with employment types broken down into 33% As Needed, and 67% Full Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $85,486 per year, or $41.1 per hour.

Travel RN Care Manager - $2,001 per week

American Traveler

Chapel Hill, NC • On-site

$2.0K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 8 days ago

Job description

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Chapel Hill, North Carolina.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 09/28/2026
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 3x12hrs
  • Hours: 36 hrs/wk
  • Start Date: Sep 28, 2026
  • Length: 13 weeks
  • Openings: 3
Description

American Traveler is hiring an experienced RN Care Manager for an acute care hospital setting requiring 2+ years of case management or care management experience and active NC or compact RN licensure.

Details
  • Work in the Care Management department of an academic medical center covering Cardiology, Nephrology, Trauma Surgery, Ortho Surgery, Vascular Surgery, Neurosurgery, GI Surgery, Urology, Transplant, and ICU/Stepdown units
  • 20-25 bed unit
  • Day shift schedule, Monday through Friday, 8:30am-5:00pm
  • 36 hours per week, 12-hour shifts, 3 days per week
  • No weekends, holidays, or on-call required
  • Uses Epic EMR for documentation and care coordination
Requirements
  • Active RN license in North Carolina (Standard or Compact) required
  • 2+ years of Care Management or Case Management experience in an acute care setting required
  • 2+ years of healthcare experience as a Registered Nurse required
  • Nursing Diploma, ADN, or ASN from an accredited nursing program required; BSN or MSN preferred
  • Strong assessment and critical thinking skills required
Additional Information
  • Provide comprehensive assessment, planning, implementation, and evaluation of individual patient care needs
  • Coordinate discharge planning and utilization review to promote continuity of care and cost-effective outcomes
  • Participate in daily Care Management touchpoints, CAPP meetings, and weekly Complex Care Meetings
  • Collaborate with Social Workers, Utilization Managers, and multidisciplinary care teams to address barriers to discharge
  • Identify and communicate expected discharge dates and monitor patient progression toward discharge readiness
  • Educate patients and families on community resources and coordinate referrals to post-acute providers
  • Experience in an academic or teaching hospital environment is helpful
  • Must be highly organized with strong attention to detail and adaptability to frequent change

American Traveler Job ID #P-752305. Pay package is based on 12 hour shifts and 36.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

American Traveler logo

About American Traveler

Sourced by ZipRecruiter

With over 20 years of success in healthcare staffing, American Traveler has established a reputation for outstanding customer service. Our full-service agency has earned top ratings from healthcare professionals in every specialty and setting. We offer travel assignments in the most sought-after locations and facilities in the country. We staff major medical centers, prestigious university teaching facilities, Magnet facilities, regional community hospitals, outpatient centers, rehab centers, skilled nursing facilities and more. With our expert team behind you every step of the way, you can enjoy a rewarding travel career that exceeds your expectations. With over 20 years of experience, American Traveler has established a reputation for outstanding customer service. With our team behind you, you can relax and enjoy a rewarding travel career.

Industry

Recruiting and staffing services

Company size

501 - 1,000 Employees

Headquarters location

Boca Raton, FL, US

Year founded

1999

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