ZipRecruiter

Log In

1

Utilization Review Rn Jobs in North Carolina (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Wilmington, NC · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Duke University

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke University

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Duke Health

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses * Quality of Life: Living in the ... Reviews records for medical necessity and collaborates with physician (s) and members of the care ...

Acadia Healthcare

Utilization Specialist

Wilmington, NC · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

previous page

Showing results 41-60

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in North Carolina

Utilization Review Rn information

See North Carolina salary details

$19

$38

$62

How much do utilization review rn jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization review rn in North Carolina is $38.43, according to ZipRecruiter salary data. Most workers in this role earn between $30.38 and $44.13 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in North Carolina? The most popular types of Utilization Review Rn jobs in North Carolina are:
What are popular job titles related to Utilization Review Rn jobs in North Carolina? For Utilization Review Rn jobs in North Carolina, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in North Carolina look for? The top searched job categories for Utilization Review Rn jobs in North Carolina are:
What cities in North Carolina are hiring for Utilization Review Rn jobs? Cities in North Carolina with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in NC? For Utilization Review Rn jobs in NC, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in North Carolina as of August 2026, with employment types broken down into 2% As Needed, 88% Full Time, 8% Part Time, and 2% Temporary. Highlights an 98% In-person, and 2% Hybrid job distribution, with an average salary of $79,926 per year, or $38.4 per hour.

Case Manager - Utilization Review

Granville Health System

Oxford, NC • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 23 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

Case Manager - Utilization Review
Location: Granville Health System, Oxford NC

About Granville Health System:

For over a century, Granville Health System has been at the forefront of quality healthcare. To cater to the evolving needs of its community, Granville Health System has extended its services throughout Granville County, ensuring convenient medical care access for its residents. The Granville Health System main campus can be found at 1010 College Street, Oxford, North Carolina. For more details, visit GHS online at www.ghsHospital.org.

About Oxford, NC

Oxford, NC is a charming and welcoming community that offers a perfect blend of small-town charm and modern convenience, making it an ideal place to live and work. Located just about 30 miles north of Durham and 40 miles from Raleigh. The region enjoys a mild, four-season climate with warm summers, crisp autumns, blooming springs, and gentle winters—perfect for enjoying the area's outdoor activities year-round. With a thriving local economy, excellent healthcare facilities, and a strong sense of community, its historic downtown, scenic parks, and proximity to the Research Triangle ensure a balanced lifestyle with both professional and personal fulfillment.

Position Overview:
The primary role of the Case Manager is to review and monitor members’ utilization of health care services with the goal of maintaining high quality, cost-effective care. This role will provide the medical and utilization review expertise necessary to evaluate patient status.  This includes reviewing clinical information against established criteria, assessing the medical necessity of services and procedures, collaborating with providers and interdisciplinary teams, and ensuring that the patient is placed at the appropriate level of care from the time of admission. This includes providing referral authorization, concurrent review, proactive discharge/transition planning, appropriate referral to case management, and high-dollar claims review.

Position Highlights:

  • Retirement Benefits: NC Local Government Pension Plan (5-year vesting period)
  • Loan Forgiveness: Eligible employer for Public Service Loan Forgiveness (PSLF)
  • Comprehensive Benefits: Medical, dental, vision, life insurance, and various supplemental benefits available

Key Responsibilities:

• Conduct concurrent review of all patients, regardless of payer source, using approved screening criteria

• Perform admission reviews on the first working day following admission

• Conduct continued stay reviews at least every three (3) days or more frequently as indicated

Qualifications

Associate degree in a healthcare-related field or equivalent combination of healthcare experience and education.                                                                    

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 access or revenue cycle support, healthcare quality or compliance functions).

Strong attention to detail, organizational skills and interpersonal skills.  Ability to interpret clinical documentation and apply review criteria.  Strong communication skills for interaction with physicians and interdisciplinary teams.  Knowledge of healthcare regulations and payer requirements

Preferred

Bachelor’s degree in Health Administration, Public Health, Social Work, Healthcare Management, or related field. Accredited Case Manager (ACM) certification. 

Experience with insurance authorization criteria preferred; one year utilization and discharge planning experience.

Apply Today:
If you're a dedicated professional looking for a position with a focus on work-life balance and the opportunity to make a difference, we encourage you to apply for this position with Granville Health System.

What Granville Health System employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply