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Utilization Review Rn Jobs in Durham, NC (NOW HIRING)

Registered Nurse Specialty: Case Management Duration: 13 weeks Shift: Days Hours per Shift: 36 ... utilization review, and discharge planning. The Care Manager must be a highly organized ...

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Review admission requests for medical necessity * Ensure proper approvals and pre-certifications ... Support urgent and emergent admissions with utilization teams * Document all patient and transfer ...

LPN/ RN

Oxford, NC · On-site

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

LPN/ RN

Oxford, NC

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

LPN/ RN

Oxford, NC · On-site

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

LPN/ RN

Oxford, NC

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

LPN/ RN

Oxford, NC · On-site

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

Showing results 41-60

Utilization Review Rn information

See Durham, NC salary details

$20

$40

$66

How much do utilization review rn jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for utilization review rn in Durham, NC is $40.82, according to ZipRecruiter salary data. Most workers in this role earn between $32.26 and $46.88 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 Durham, NC? The most popular types of Utilization Review Rn jobs in Durham, NC are:
What cities near Durham, NC are hiring for Utilization Review Rn jobs? Cities near Durham, NC with the most Utilization Review Rn job openings:
Infographic showing various Utilization Review Rn job openings in Durham, NC as of August 2026, with employment types broken down into 5% As Needed, 79% Full Time, 11% Temporary, and 5% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $84,909 per year, or $40.8 per hour.

$2.3K/wk

Other

Posted 4 days ago


Carilion Clinic rating

6.9

Company rating: 6.9 out of 10

Based on 214 frontline employees who took The Breakroom Quiz

453rd of 887 rated healthcare providers


Job description

Details
Client Name
Cone Health - Alamance Regional Medical Center
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Case Manager
Job ID
37698641
Job Title
RN - Case Manager
Weekly Pay
$2319.75
Shift Details
Shift
8a-4p
Scheduled Hours
40
Job Order Details
Start Date
08/24/2026
End Date
11/23/2026
Duration
13 Week(s)
Job Description
ID: 64353791 Shift: Day 5x8-Hour (07:00 - 15:30) Description: MANDATORY QUESTIONNAIRE*Please answer the following questions and send back ASAP. An offer cannot me made without these answers.*1. Is your candidate aware that they are being submitted to Cone and have you reviewed the job description with them? (Y or N)2. Is your candidate flexible with scheduling and aware that the client has a zero-tolerance policy for tardiness and unexcused absences? (Y or N)3. Are there any barriers (ex. upcoming vacation) that would prevent your candidate from completing compliance on time? The compliance deadline is 12 Noon EST the Wednesday prior to the start date. (Y or N)4. Is your candidate aware of the Pass Fail EKG exam required by all RNs for Cone Health regardless of specialty? (Y or N)5x8s, Days, 7a-330pMonday - FridayMinimum 2 yrs exp required. NO FIRST TIME TRAVELERS.*BLS*Acute Hospital exp req*Exp w ICU, MS, PICU, SDU, PCU, IMC, Obs specialties req*Previous Charge exp req*EPICCase Mgmt and Utilization Review*Discharge planning, Needs Assessment, Order DME, Plan of Care reqRegulatory Exp*CMS - Centers for Medicare and Medicaid Services Modified Time:8/24/2026 12:00:00 AM Account Manager: Hayley Alloe Account Manager Email: Hayley.Alloe@qualivis.com COVID-19 Vaccine: Required - Medical/Religious Exemptions Only Flu Vaccine: Required - Medical/Religious Exemptions Only Submittals:Med Job Requirements & Qualifications Previous Charge Experience : Preferred Years of Experience : 1 Patient Ratio Experience : 30 Charting System Experience : Required Charting System Name : Epic Community Hospital Experience : - LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : - Certifications : BLSSkills : Acute Hospital, Care coordination, Discharge Planning, Emergency Department*, ICU, MS, Needs Assessment/ Order DME, SDU/PCU/IMC/Obs, Surgical Services, Women s Services* Unit Details Staffing & Scheduling Scheduling Type : - Patient Ratios Days : - Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : - Number of Weekend Shifts Per Contract : - Pre-Approved Time Off : - Orientation Hours : - Facility & Patient Care Details Patient Age Groups : Neonates, Adolescents, Infants, Adults, Geriatrics Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : - Special Procedures/Unit Details : - Special Equipment : - #Tier2 Travel Compliance RTO: Must be submitted with the application; no post-submission RTO accepted. Education: Third-party education verification required. Degrees from schools on the Florida Diploma Fraud Audit list will not be accepted. Background Check: No open cases permitted. License: Active license must be in hand at submission. Local Policy: No local candidates within a 50-mile radius. Current driver's license required to verify address. EMR Experience: EPIC experience required. Floating: Travelers may be floated to any Cone Health campus as needed. EKG Exam : All RNs, regardless of specialty, must pass a compliance EKG exam (2 attempts allowed). Modules : Modules are non-billable, average 2-4 hours Modules are completed during orientation, not included in NBO Module hours are unit based, hours will vary Submittal Details: #Tier2 Travel ComplianceRTO: Must be submitted with the application; no post-submission RTO accepted.Education: Third-party education verification required. Degrees from schools on the Florida Diploma Fraud Audit list will not be accepted.Background Check: No open cases permitted.License: Active license must be in hand at submission.Local Policy: No local candidates within a 50-mile radius. Current driver's license required to verify address.EMR Experience: EPIC experience required.Floating: Travelers may be floated to any Cone Health campus as needed.EKG Exam: All RNs, regardless of specialty, must pass a compliance EKG exam (2 attempts allowed).Modules:Modules are non-billable, average 2-4 hoursModules are completed during orientation, not included in NBOModule hours are unit based, hours will vary Guaranteed Hours: Contract Weeks:91
Client Details
City
Burlington
State
NC
Zip Code
27215

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About Carilion Clinic

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This is Carilion Clinic ... An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious. Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute. Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Roanoke, VA, US

Year founded

1899