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Behavioral Health Insurance Clinical Reviewer Jobs

Kinwell

Behavioral Health Clinician

Spokane, WA · On-site

$62K - $85K/yr

... clinical standards in the provision of mental health services. * Participate in peer review of EHR ... Medical/Vision/Dental Insurance * Personal Funding Accounts (HSA, FSA, DCA) * 401K * Basic Life ...

Virtix Health LLC

Clinical Quality Reviewer

About Us: Our purpose is to help clients exceed their financial health goals. Across the ... The Clinical Reviewer combines clinical expertise with strong analytical and documentation skills ...

City of Tampa Florida

Behavioral Health Clinician

Tampa, FL · On-site

$44.48 - $66.66/hr

Assists in the review and development of clinical policies, procedures, and guidelines for the ... to behavioral health. Excellent knowledge, education, and training in the field of mental health ...

Comagine

Clinical Reviewer RN - Alabama

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality ...

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How much do behavioral health insurance clinical reviewer jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for behavioral health insurance clinical reviewer in the United States is $35.92, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $40.38 per hour, depending on experience, location, and employer.

What is a behavioral health insurance clinical reviewer?

A Behavioral Health Insurance Clinical Reviewer is a healthcare professional, often with a background in nursing, social work, or psychology, who evaluates mental health and substance use disorder treatment requests for insurance companies. Their primary role is to review clinical documentation, assess the medical necessity of proposed treatments, and determine whether services meet insurance coverage criteria. They ensure that patients receive appropriate care while also helping insurance providers manage costs and comply with regulations. This position often involves communicating with providers, patients, and other healthcare professionals to gather additional information and make informed decisions.

What are the key skills and qualifications needed to thrive as a behavioral health insurance clinical reviewer?

To thrive as a Behavioral Health Insurance Clinical Reviewer, you need a clinical background in behavioral health (such as an RN, LCSW, LPC, or LMFT license) and in-depth knowledge of mental health diagnoses and treatment protocols. Familiarity with utilization management software, electronic health records, and evidence-based guidelines is typically required, along with certification in case management or utilization review being a plus. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating cases and collaborating with healthcare providers. These competencies ensure fair, evidence-based coverage determinations that support patient care while adhering to insurance policies and regulatory standards.

What are some common challenges faced by behavioral health insurance clinical reviewers, and how can they be managed?

Behavioral Health Insurance Clinical Reviewers often face the challenge of balancing clinical judgment with insurance policies and regulations. Navigating complex cases where coverage criteria and patient needs do not always align can be demanding. Managing high caseloads and tight deadlines requires strong organizational skills and attention to detail. Building effective communication with providers and members is key to resolving disputes and ensuring appropriate care. Staying updated on changing regulations and evidence-based guidelines also helps reviewers make informed decisions and maintain compliance.

What is the difference between Behavioral Health Insurance Clinical Reviewer vs Mental Health Case Manager?

AspectBehavioral Health Insurance Clinical ReviewerMental Health Case Manager
CredentialsLicenses or certifications in behavioral health, clinical review certificationsLicensed mental health professional, social worker, or counselor
Work EnvironmentInsurance companies, utilization review departmentsHospitals, clinics, community agencies
Employer & IndustryHealth insurance providers, managed care organizationsHealthcare facilities, mental health agencies
Primary FocusReviewing insurance claims for behavioral health servicesCoordinating care and supporting patients' mental health needs

The main difference is that Behavioral Health Insurance Clinical Reviewers focus on evaluating insurance claims and determining coverage, while Mental Health Case Managers coordinate patient care and support treatment plans. Both roles require behavioral health knowledge but serve different functions within the healthcare system.

What are popular job titles related to Behavioral Health Insurance Clinical Reviewer jobs?

For Behavioral Health Insurance Clinical Reviewer jobs, the most frequently searched job titles are:

Infographic showing various Behavioral Health Insurance Clinical Reviewer job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 77% Full Time, 16% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $74,707 per year, or $35.9 per hour.

Medical Director, Behavioral Health (PST Zone)

Washington, CA • On-site

Molina Healthcare
Health Care and Social Assistance • 10K+ employees
Learn more about Molina Healthcareexternal

$186K - $363K/yr

Full-time

Re-posted 4 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

172nd of 315 rated insurance

Job description

JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.
Facilitates behavioral health-related regional medical necessity reviews and cross coverage.
Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.
Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.
Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.
Provides second level behavioral health clinical reviews, peer reviews and appeals.
Supports behavioral health committees for quality compliance.
Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.
Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).
Assists with the recruitment and orientation of new psychiatric medical directors.
Ensures all behavioral health programs and policies are in line with industry standards and best practices.
Assists with new program implementation and supports for health plan in-source behavioral health services.
Required Qualifications
At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience.
Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice.
Board Certification in Psychiatry.
Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
Ability to work cross-collaboratively within a highly matrixed organization.
Strong organizational and time-management skills.
Ability to multi-task and meet deadlines.
Attention to detail.
Critical-thinking and active listening skills.
Decision-making and problem-solving skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
Preferred Qualifications
Experience with utilization/quality program management.
Managed care experience.
Peer review experience.
Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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