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

Granville Health System

RN-ED

Oxford, NC · On-site

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC · On-site

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC · On-site

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC · On-site

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC · On-site

$32.75/hr

Registered Nurse # Emergency Department Location: Granville Health System, Oxford, NC # About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

Granville Health System

RN-ED

Oxford, NC

$32.75/hr

Registered Nurse - Emergency Department Location: Granville Health System, Oxford, NC About ... Provides appropriate nursing interventions as ordered by physician and through utilization of ...

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

Utilization Review Rn information

See Raleigh, NC salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Jun 14, 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.

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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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 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 June 2026, with employment types broken down into 85% Full Time, and 15% Part Time. Highlights an 85% In-person, and 15% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.
Travel RN Case Manager Henderson NC

Travel RN Case Manager Henderson NC

Vibra Travels

Henderson, NC

Other

Posted 21 days ago

Job description

Overview
Unlike working for agency after agency, with our travel program, you get to work for a company:
• Work with 1 recruiter from start to finish and assignment to assignment
• Local and Non-local positions available
• Competitive hourly rate in addition to tax-free stipend (if applicable)
• No pay cuts mid-contract
• Referral bonus (up to $1000 per referral!)
• License reimbursement if traveling to new state where new license is required
• Your pick of assignments at partner facilities from various health systems across the country
Responsibilities
Position Summary:
Responsibility to coordinate clinically complex patient's care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services and resources needed by the patients, and at key points, intervening to address and resolve issues/concerns in assigned facility. Key in ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan. Demonstrate knowledge and skills necessary to provide case management services to the patient population experiencing rehabilitation needs.
Position Supervisory Responsibilties:
Supervises the following positions: None
Qualifications
Minimum Qualifications:
  • Current, valid, and active license to practice as a Registered Nurse or Licensed Social Worker in the state of employment required.
  • Current BLS certification from a Vibra-approved vendor required.
  • Current, valid, and active driver's license required.
  • Ability to travel using publicly available air and ground transportation
Additional Qualifications/Skills:
  • One (1) year of case management experience preferred. Previous Critical Care experience preferred.
  • CCM or ACM certification preferred.
  • Working knowledge and ability to apply professional standards of practice in job situations.
  • Must be assertive and personable with the ability to balance the complex challenge of delivering quality, cost-appropriate, and service-oriented outcomes.
  • Demonstrates comprehensive knowledge of the principles and concepts of case management and applicable standards of voluntary and regulatory agencies for review activities.
  • Proficient in collecting and retrieving material from medical records.
  • Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models.
  • Communication skills, both written and oral, must be outstanding and practiced with all internal and external business relationships.
  • Interpersonal relationship abilities must be highly refined with negotiation and problem solving skills at a very high level.
  • Must possess strong clinical assessment and process skills.
  • Critical thinking skills must be demonstrated in all situations.
  • Ability to project a professional image.
  • Knowledge of regulatory standards and compliance requirements.
  • Strong organizational, prioritizing and analytical skills.
  • Ability to make independent decisions when circumstances warrant.
  • Working knowledge of computer and software applications used in job functions.
  • Freedom from illegal use of and effects of use of drugs and alcohol in the workplace.

Certificates, Licensures, Registrations
Current, valid, and active license to practice as a Registered Nurse or Licensed Social Worker in the state employed. CCM preferred. Current BLS certification from a Vibra-approved vendor required.
Per Federal Health Care Worker Vaccine Requirements, all employees must be fully vaccinated against COVID-19 or be approved for a valid religious or medical exemption. Anyone hired by the company must provide proof of their COVID-19 vaccine before they can begin employment or request and be approved for a valid religious or medical exemption. Unvaccinated employees on an approved exemption must submit to weekly COVID-19 testing and wear a respirator at all times while in the facility. Some states and locations require increased frequency testing pursuant to state regulations.
To find out more information or check out our website at https://www.vibratravels.com
Our recruitment team wants to get to know you. Share your passion! Please complete our online application and submit your resume for immediate consideration.
Thank you for taking the time to consider our career opportunities.
The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system: a. Notice of E-Verify Participation b. Notice of Right to Work
Posters
Participating employers must display the E-Verify Participation and Department of Justice, Immigrant and Employee Rights Section (IER) Right to Work posters to inform their current and prospective employees of their legal rights and protections.
As an employee of Vibra Travel's, you will be eligible to enroll in Medical and Prescription benefits once you meet the eligibility requirements outlined by the Affordable Care Act (ACA).
Vibra Travels logo

About Vibra Travels

Sourced by ZipRecruiter

Vibra Healthcare, known for its commitment to patient wellness, provides compassionate medical and rehabilitation services to individuals recovering from serious injuries, illnesses, and medical conditions. The dedicated team at Vibra works tirelessly to deliver personalized care, maintaining a culture of teamwork and clinical service excellence. The pay package is based on 12-hour shifts and 36 hours per week (subject to confirmation), and a tax-free stipend will be determined accordingly.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Mechanicsburg, PA, US

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