Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Utilization Review Nurse
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Conduct initial and concurrent utilization reviews for admitted and observation patients, ensuring compliance with regulatory and payer requirements. Partner with interdisciplinary teams to ...
Conduct initial and concurrent utilization reviews for admitted and observation patients, ensuring compliance with regulatory and payer requirements. Partner with interdisciplinary teams to ...
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
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 health ...
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 health ...
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 health ...
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 health ...
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 health ...
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 health ...
Formulary Strategy & Utilization Review Pharmacist
Raleigh, NC · On-site
$56.50 - $68/hr
Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: * Review prescribing trends and propose cost-saving ...
Formulary Strategy & Utilization Review Pharmacist
Raleigh, NC · On-site
$56.50 - $68/hr
Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: * Review prescribing trends and propose cost-saving ...
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested * Engage in care management ...
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested * Engage in care management ...
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested * Engage in care management ...
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice standards and to determine if services were delivered as requested * Engage in care management ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Utilization Manager
Durham, NC · On-site
Reviews records for medical necessity and collaborates with physician (s) and members of the care ... Provides education and feedback to the Utilization Managers and Providers. ED UM/CM Proactive CM ...
Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. * Identifies potential Third-Party ...
Quick apply
Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. * Identifies potential Third-Party ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Utilization Management Nurse
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member's benefit coverage while working ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Review information
See Raleigh, NC salary details
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
How much do utilization review jobs pay per hour?
As of Aug 11, 2026, the average hourly pay for utilization review 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.
Is utilization review work from home?
Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.
What does a utilization review do?
A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.
Is utilization review a stressful job?
Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.
What is a utilization review?
A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.
What are the key skills and qualifications needed to thrive in utilization review?
To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.
How do I get into a utilization review?
To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Raleigh, NC? The most popular types of Utilization Review jobs in Raleigh, NC are:
What are popular job titles related to Utilization Review jobs in Raleigh, NC? For Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
- Utilization Review Nurse
- Utilization Management
- Night Utilization Review Nurse
- Overnight Utilization Review Nurse
- Evening Utilization Review Nurse
- Evening Optum Health Utilization Review
- Full Time Remote Utilization Review Nurse
- Utilization Review Physician
- Home Based Utilization Review Nurse
- No Experience Utilization Management Nurse
What job categories do people searching Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Utilization Review jobs? Cities near Raleigh, NC with the most Utilization Review job openings:
Granville Health System rating
8.6
Based on 5 frontline employees who took The Breakroom Quiz
Job description
Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.
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