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

Daymark Recovery Services

Registered Nurse

Erwin, NC · On-site

Registered Nurse Good Hope Hospital - Erwin, NC 28339 Description Our mission is to inspire and ... Participates in peer review process for therapists * All other duties as assigned by supervisor ...

Liberty Healthcare

HOSPICE REGISTERED NURSE

Dunn, NC · On-site

Attend and participate in IDT meetings and quality review as scheduled by agency. Job Requirements: * Current RN licensure in state of practice, successful completion of a nursing education from an ...

Liberty Health

HOSPICE REGISTERED NURSE

Dunn, NC

Attend and participate in IDT meetings and quality review as scheduled by agency. Job Requirements: * Current RN licensure in state of practice, successful completion of a nursing education from an ...

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Utilization Review Rn information

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$38

$63

How much do utilization review rn jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review rn in Fayetteville, NC is $38.86, according to ZipRecruiter salary data. Most workers in this role earn between $30.72 and $44.62 per hour, depending on experience, location, and employer.

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.

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.

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.

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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Fayetteville, NC?

The most popular types of Utilization Review Rn jobs in Fayetteville, NC are:

What are popular job titles related to Utilization Review Rn jobs in Fayetteville, NC?

For Utilization Review Rn jobs in Fayetteville, NC, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Fayetteville, NC look for?

The top searched job categories for Utilization Review Rn jobs in Fayetteville, NC are:

What cities near Fayetteville, NC are hiring for Utilization Review Rn jobs?

Cities near Fayetteville, NC with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Fayetteville, NC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $80,822 per year, or $38.9 per hour.

PRN Utilization Review Admin

Daymark Recovery Services, Inc.

Erwin, NC • On-site

$18 - $23/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Daymark Recovery Services rating

6.2

Company rating: 6.2 out of 10

Based on 17 frontline employees who took The Breakroom Quiz

Job description

Company Mission/ statement:
Our mission is to inspire and empower people to seek and maintain recovery and health. Daymark Recovery Services, Inc. is a mission driven, comprehensive community provider of culturally sensitive mental health and substance abuse services.
Comprehensive Benefits Package:
  • Medical, Dental and Vision Insurance
  • Health Spending Account
  • Company-Paid Life Insurance
  • Short Term Disability
  • 401(k)
  • Paid Holidays
  • Paid Vacation and Sick Leave
  • Employee Assistant Program
  • Referral Bonus Opportunities
  • Extensive Internal Training Program

Pay Scale: $18.00-23.00/hr. salary based on education and experience
Summary:
The Utilization Review Coordinator initiates pre-certification calls for private insurance and managed Medicare and Medicaid plans and provides concurrent reviews throughout the patient stays.
Essential Duties and Responsibilities:
  • Tracks utilization review outcomes
  • Assess and reassesses the quality of patient progress notes
  • Maintains insurance contact information
  • Manages insurance appeal process and work with the client hospital's denial management coordinator
  • Communicates treatment team recommendations
  • Attends treatment team meetings
  • Participates as an active member of the interdisciplinary team
  • Addresses issues in a timely manner and informs Program Director of progress
  • Provides ongoing education to management and staff for performance improvement
  • Continuous education of legislative and insurance changes in regard to continued stay requirements
  • Provides resources and suggestions to third party payors regarding aftercare and discharge continued care
  • Performs as liaison with appropriated interested parties and physicians through the utilization process
  • Responds to requests for general information about the unit's treatment program, and provides information about appropriate topics in response to community requests. Informs Program Director and Nurse Manager of any issues identified by insurance reviewers
  • Coordinates treatment with other health and social agencies
  • Identifies areas needing improvement and utilizes the facility performance improvement process
  • Disseminates pertinent findings/data to referral sources as needed
  • Stays informed on all clinical services and program changes in order to appropriately represent payor sources
  • Completes all pertinent staff competencies
  • All other duties as assigned by supervisor

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
  • Highly motivated and resilient professional
  • Strong negotiation skills
  • Demonstrated leadership and supervisory experience
  • Demonstrated ability to positively lead change and gain results
  • Some knowledge of or willing to learn clinical practice models
  • Demonstrated ability to understand economic, business and operational factors
  • Preceptor and teaching experience helpful
  • Strong critical-thinking/problem-solving skills
  • Proven conflict management/resolution skills
  • High professional ethics and standards
  • Strong team player and team building skills; ability to collaborate with all levels and areas
  • Strong presentation skills
  • Proven relationship-building and management skills
  • Ability to effectively and positively influence and persuade

Education and/or Experience: A Bachelor's Degree from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing or other related field is preferred; and/orMinimum three years' of experience in a similar position and/or industry.

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