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Utilization Review Jobs in Raleigh, NC (NOW HIRING)

Pharmacy Careers

Remote Clinical Review Pharmacist

Raleigh, NC · On-site

$115K - $137K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

New

Humana

Compliance UM Nurse (Wed - Sun)

Raleigh, NC · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

Integrated Resources

RN-Care Manager

Chapel Hill, NC · On-site

Conduct utilization review and case management activities. * Participate in daily Care Management Touchpoint (CAPP) meetings. * Attend weekly Complex Care Meetings (CCM) and collaborate on high-risk ...

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Showing results 21-40

All JobsUtilization Review JobsUtilization Review Jobs in Raleigh, NC

Utilization Review information

See Raleigh, NC salary details

$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:
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:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 79% Full Time, 4% Part Time, and 17% Contract. Highlights an 92% In-person, 4% Hybrid, and 4% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Travel Nurse RN - Case Manager, Utilization Review

AMN Healthcare Revenue Cycle

Chapel Hill, NC • On-site

$1.8K - $2.7K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Chapel Hill, North Carolina.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 08/24/2026
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours
  • Employment Type: Travel

Job Description & Requirements
RN Care Manager
StartDate: 8/24/2026 Pay Rate: $1800.00 - $2700.00

POSITION SUMMARY – RN Care Manager

POSITION DUTIES – Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. Enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. Highly organized professional with great attention to detail, adaptable to frequent change, and compliant with regulatory and departmental guidelines and policies.

MINIMUM REQUIRED QUALIFICATIONS –

  • Nursing Diploma or ADN / ASN from an accredited school of Nursing
  • NC/compact RN license
  • 2 years acute care hospital case management experience
  • Care manager / discharge planning experience

PREFERRED QUALIFICATIONS –

  • EPIC experience
  • Experience with educational/teaching hospital
  • BSN or MSN from an accredited school of Nursing

LENGTH OF ASSIGNMENT – 13 weeks

SHIFT / HOURS PER WEEK – 8:00am-5:00pm

SYSTEMS – Epic

START DATE – ASAP


Facility Location
Home to the University of North Carolina at Chapel Hill and part of the prestigious Research Triangle, Chapel Hill offers travelers an exciting mix of career building opportunities and leisure activities. Visit one of the city’s unique eateries for distinctive home cooking, or explore the campus of Chapel Hill for some beautiful natural scenery and an eclectic arts and music scene.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3552313. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Care Manager

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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