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

Duke University

Utilization Manager

Durham, NC · On-site

Duke University Health System has 6000 + registered nurses Quality of Life: Living in the Triangle ... 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

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 ...

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

Utilization Review Rn information

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$41

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How much do utilization review rn jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review rn 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 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 Raleigh, NC?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Raleigh, NC as of August 2026, with employment types broken down into 8% As Needed, 65% Full Time, 8% Part Time, 5% Temporary, and 14% Contract. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $85,486 per year, or $41.1 per hour.

Utilization Review Nurse (RN)

Integrated Resources

Raleigh, NC • On-site

Other

Re-posted 9 days ago

Job description

Utilization Review Nurse (RN)

A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

· The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care.

· Advanced assessment and teaching skills.

· Problem solving skills.

· Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues.

· Utilization and Quality Management/Outcomes experience preferred.

· Previous work experience with a managed care organization or provider is also preferred.

· Prior experience in case management, home health, discharge planning, or Concurrent review.

· RN Diploma, RN Associate's degree or Bachelors of Science in Nursing (BSN) degree.

· Minimum of 3 years clinical experience in an acute medical or acute surgical setting.

· Proficiency with a Microsoft Windows operating system.

· Must have valid license to practice nursing within the US and have started application for NC nursing license.

Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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