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

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Work with the business office and the utilization review department to ensure payment for services ... Schedules CPEs, nursing assessments, H&P and psychosocial assessment with appropriate clinician and ...

Team Select Home Care

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

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

Team Select Home Care

Case Manager

Raleigh, NC · On-site

$19.50 - $25/hr

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

Lifepoint Health

Office Coordinator

Raleigh, NC · On-site

$15.50 - $20.50/hr

Work with the business office and the utilization review department to ensure payment for services ... Schedules CPEs, nursing assessments, H&P and psychosocial assessment with appropriate clinician and ...

AmSurg Corp

Pre Admin Nurse RN

Clayton, NC · On-site

$65 - $85/hr

Support efficient room turnover and appropriate utilization of supplies Documentation, Safety ... For further information, please review the Know Your Rights notice from the Department of Labor. #J ...

Wake Endoscopy Center LLC

Pre Admin Nurse RN

Clayton, NC · On-site

$55 - $83/hr

Support efficient room turnover and appropriate utilization of supplies Documentation, Safety ... For further information, please review the Know Your Rights notice from the Department of Labor. #J ...

AMSURG

Pre Admin Nurse RN

Clayton, NC · On-site

Support efficient room turnover and appropriate utilization of supplies Documentation, Safety ... For further information, please review the Know Your Rights notice from the Department of Labor.

Duke University

Registered Nurse

Durham, NC · On-site

Review and interpret treatment orders and protocols. * Coordinate communication with external ... Promote effective utilization of clinical resources and equipment. * Support infection prevention ...

Duke University

Registered Nurse

Durham, NC · On-site

Review and interpret treatment orders and protocols. * Coordinate communication with external ... Promote effective utilization of clinical resources and equipment. * Support infection prevention ...

IVX Health

Infusion Registered Nurse (RN)

Cary, NC · On-site

Ensure Compliance and Quality - Maintain accurate records in the Electronic Health Record (EHR) system, review nursing documentation, and uphold HIPAA and OSHA standards. * Optimize Clinical ...

Lifepoint Health

Therapist, Inpatient PRN

Raleigh, NC · On-site

$34.25 - $46.50/hr

Works well with the interdisciplinary team including physicians, utilization review and nursing staff members * Demonstrates active communication with team members * Effectively communicates to UR on ...

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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 6, 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.

Office Coordinator

Lifepoint Health

Raleigh, NC • On-site

$15.50 - $20.50/hr

Full-time

Re-posted 5 days ago

LifePoint Health rating

5.9

Company rating: 5.9 out of 10

Based on 273 frontline employees who took The Breakroom Quiz

766th of 898 rated healthcare providers

Job description

Office Coordinator

This position is responsible for supporting the needs of the department with a focus on clinical, operational, and administrative excellence.

Essential Functions

  • Maintains supply of therapeutic tools such as worksheets, videos, and games for clinician use
  • Per the therapist dictation maintains the programming schedule
  • Supports with charge reconciliation and entering as required
  • Supports team with patient group assignments and coordination efforts
  • Provides impeccable customer service to patients, families, referral sources, and stakeholders
  • Supports with vital and UDS capture as needed
  • Completes DCAR reporting in a timely and accurate fashion
  • Supports in organizing and filing paperwork
  • Maintains staff schedules and ensures staffing for the program
  • Monitors and records attendance including tardiness and absences
  • Communicates with treatment team to ensure chart compliance
  • Interfaces with others to ensure completion of physician follow-ups from CPE
  • Manages Family Session Schedules as required by program
  • Work with the business office and the utilization review department to ensure payment for services
  • Preform pre-certifications and concurrent reviews
  • Develop relationships with payer sources
  • Interfaces with UR department to ensure service coverage for patients
  • Maintain a positive working relationship with referral sources, community agencies and organizations
  • Maintains program and patient information and data to create reports, census, and assist the Business Office in reporting
  • Schedules CPEs, nursing assessments, H&P and psychosocial assessment with appropriate clinician and per required timeframe
  • Schedules or completes UDS collections, including random screenings
  • Ensures orders are obtained for patients prior to starting services (as applicable)
  • Actively participate in the therapist's discharge planning needs
  • As directed creates appointments, starts follow up care process and completes interfacing with organizations
  • Cross trains and supports in various outpatient functions including PCA, transportation, and financial counseling
  • Conducts appointment reminder calls
  • Collects copays and deductibles as applicable
  • Manages organizational tools to ensure efficient operations including bed boards/group room assignments, treatment team schedule, flash reports, etc
  • Other responsibility and duties assigned by leadership

Additional Information

  • Reports to: Outpatient Clinical Director
  • FLSA Status: none exempt
  • Previous experience on an inpatient unit preferred. Must have experience with clerical duties.

Education: High School Diploma/GED preferred.

Certifications: CPR and De-escalation certification required or obtain within 30 days of hire.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

What LifePoint Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

Social media

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