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Behavioral Health Utilization Management Jobs in Minnesota

Medica

Utilization Management RN III

Minnetonka, MN · On-site

$70K - $120K/yr

Description Medica is a nonprofit health plan with more than a million members that serves ... Utilization Management experience * Knowledge surrounding regulatory requirements (i.e. CMS and ...

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All JobsBehavioral Health Utilization Management JobsBehavioral Health Utilization Management Jobs in Minnesota

Behavioral Health Utilization Management information

See Minnesota salary details

$20

$41

$67

How much do behavioral health utilization management jobs pay per hour?

As of Aug 2, 2026, the average hourly pay for behavioral health utilization management in Minnesota is $41.41, according to ZipRecruiter salary data. Most workers in this role earn between $32.74 and $47.55 per hour, depending on experience, location, and employer.

What is the difference between Behavioral Health Utilization Management vs Behavioral Health Case Manager?

AspectBehavioral Health Utilization ManagementBehavioral Health Case Manager
CredentialsLicenses (e.g., RN, LCSW), certifications in utilization reviewLicenses (e.g., LCSW, LPC), case management certifications
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community clinics, outpatient facilities
Employer & Industry UsageHealth insurance providers, managed care organizationsBehavioral health agencies, hospitals, outpatient clinics

Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.

What are some common challenges faced by Behavioral Health Utilization Management professionals, and how are they typically addressed?

Behavioral Health Utilization Management professionals often encounter challenges such as managing high caseloads, keeping up with evolving clinical guidelines, and ensuring timely communication with providers and insurance companies. Balancing the need for cost containment with advocating for appropriate patient care can also be demanding. These challenges are typically addressed through ongoing training, strong teamwork, and the use of evidence-based criteria and decision-support tools to guide determinations and streamline workflows.

What is Behavioral Health Utilization Management?

Behavioral Health Utilization Management is a process used by insurance companies and healthcare organizations to evaluate the necessity, appropriateness, and efficiency of behavioral health services such as mental health and substance use treatments. This process helps ensure that patients receive the right level of care based on clinical guidelines while managing healthcare costs. Utilization managers review treatment plans, authorize services, and coordinate with providers to promote quality outcomes and avoid unnecessary services. Their work is essential in balancing patient needs with resource allocation in the healthcare system.

What are the key skills and qualifications needed to thrive as a Behavioral Health Utilization Management professional, and why are they important?

To thrive as a Behavioral Health Utilization Management professional, you need a background in behavioral health or clinical care, often with an RN, LCSW, LPC, or similar licensure and experience in mental health care settings. Familiarity with utilization review software, insurance guidelines, and electronic health record (EHR) systems is crucial. Strong analytical thinking, communication, and negotiation skills are essential soft skills to effectively evaluate treatment plans and coordinate with providers. These competencies are vital to ensuring appropriate, cost-effective care while maintaining compliance with regulatory and payer requirements.
What are popular job titles related to Behavioral Health Utilization Management jobs in Minnesota? For Behavioral Health Utilization Management jobs in Minnesota, the most frequently searched job titles are:
What job categories do people searching Behavioral Health Utilization Management jobs in Minnesota look for? The top searched job categories for Behavioral Health Utilization Management jobs in Minnesota are:
What cities in Minnesota are hiring for Behavioral Health Utilization Management jobs? Cities in Minnesota with the most Behavioral Health Utilization Management job openings:
Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Minnesota as of July 2026, with employment types broken down into 75% Full Time, and 25% Part Time. Highlights an 96% In-person, 2% Hybrid, and 2% Remote job distribution, with an average salary of $86,136 per year, or $41.4 per hour.

Senior Business Analyst - Utilization Management/Behavioral Health

Blue Cross and Blue Shield of Minnesota

Eagan, MN • On-site

$94K - $121K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Blue Cross Blue Shield Of Minnesota rating

6.0

Company rating: 6.0 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

280th of 301 rated insurance

Job description

About Blue Cross and Blue Shield of Minnesota
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Impact You'll Have
Blue Cross and Blue Shield of Minnesota is seeking a Senior Business Analyst to join our Utilization Management (UM) Product team, with a focus on Behavioral Health (BH). In this highly visible role, you will serve as the Behavioral Health subject matter expert, helping shape strategy and drive initiatives that improve affordability, quality, and member outcomes. Working closely with product leaders, clinical partners, and business stakeholders, you will translate complex behavioral health clinical and operational insights into actionable business requirements, impact analyses, and implementation plans that support enterprise priorities.
The ideal candidate brings strong analytical skills, business acumen, and a passion for improving healthcare delivery. You will identify and advance Behavioral Health affordability opportunities by evaluating utilization trends, reimbursement gaps, medical necessity alignment, payment accuracy, and benefit design considerations. Through deep-dive analysis of claims, provider performance, and utilization patterns, you will uncover opportunities to optimize processes, strengthen financial stewardship, and support data-driven decision making across the Utilization Management organization.What You'll Do
  • Develop and present data-driven business cases to support Utilization Management initiatives, evaluating clinical evidence, utilization trends, and potential cost-saving opportunities in partnership with Product, Clinical, and Operational stakeholders.
  • Analyze prior authorization and reimbursement opportunities, assessing the impact of benefit, coding, and utilization management changes to improve affordability and care quality outcomes.
  • Conduct operational and regulatory assessments of Utilization Management processes, identifying gaps, compliance considerations, and opportunities to align with state and federal requirements while improving efficiency.
  • Identify and recommend process improvement and affordability opportunities by combining operational insights, clinical criteria, financial modeling, and industry benchmarks to support strategic decision-making and drive measurable results.
How You'll Do It
  • Conducts in-depth research and analysis.
  • Analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems or processes.
  • Develops and documents metrics and process changes.
  • Coordinates individual projects and related activities to ensure project/stories progress on schedule.
  • Maintains communication regarding project status, risks, issues, and priorities with project stakeholders and leadership.
  • Responsible for representing the customer and/or internal and external stakeholders while collaborating with business and technical units.
  • Oversight of internal or external downstream entities to ensure defined business requirement activities are fulfilled.
  • Identifies trends, emerging issues, and recommends best practices to ensure maximum results.
  • Acts as a liaison with internal and external partners to identify opportunities and needs. Researches and develops implementation plans for meeting business needs.
  • Serves as senior subject matter expert associated with content, processes, and procedures.
  • May lead project teams and may provide training to junior level staff or other team members to achieve project milestones and objectives.
  • Performs additional responsibilities consistent with the scope and level of the role, as assigned.
Required Skills & Experience
  • 5+ years of related information technology professional experience.
  • Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience
  • Clinical background with Utilization Management and Behavioral Health experience.
  • Experience analyzing and interpreting complex data to identify trends, insights, and business opportunities.
  • Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
  • Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
  • Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
  • Proficiency with business technology platforms, systems, software, and tools.
  • Understanding of business operations, processes, or domain context.
  • Ability to analyze information and support business decisions, solutions, or process outcomes.
Role Designation
Hybrid
Role designation definition:
  • Teleworking is working full time remote.
  • Hybrid is a minimum of 2 days onsite.
  • Onsite is full-time onsite.

Anchored in Connection
Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.
Compensation and Benefits
$90,800.00 - $120,300.00 - $149,800.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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