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Behavioral Health Utilization Management Jobs in Nevada

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

Minimum three (3) years of Utilization Management experience. * Minimum of three (3) year ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV · On-site

Minimum three (3) years of Utilization Management experience. * Minimum of three (3) year ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

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Behavioral Health Utilization Management information

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$43

$70

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

As of Aug 13, 2026, the average hourly pay for behavioral health utilization management in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 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 common challenges in behavioral health utilization management and how are they 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 skills and qualifications are needed for behavioral health utilization management?

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 Nevada? For Behavioral Health Utilization Management jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Behavioral Health Utilization Management jobs in Nevada look for? The top searched job categories for Behavioral Health Utilization Management jobs in Nevada are:
Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Nevada as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, and 4% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $89,556 per year, or $43.1 per hour.

Utilization Review Nurse | Full Time

Lancesoft INC

Las Vegas, NV • On-site

$41 - $60/hr

Full-time

Medical, Dental, Life

Re-posted 14 days ago

Job description

Job Description – Utilization Review Nurse

Position Summary
The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary, appropriate, and cost-effective care. This role evaluates clinical documentation against established utilization review criteria, payer requirements, and regulatory standards while collaborating with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and resource utilization.

Key Responsibilities

  • Review patient admissions and continued stays for medical necessity, appropriateness of care, and compliance with payer guidelines.
  • Apply InterQual and Milliman criteria to determine appropriate levels of care.
  • Ensure compliance with Medicare, Medicaid, commercial insurance, and regulatory requirements.
  • Analyze medical records to verify accurate clinical documentation and identify opportunities for improvement.
  • Collaborate with physicians, case managers, clinical documentation specialists, and other healthcare professionals to facilitate appropriate patient care and discharge planning.
  • Participate in utilization management activities, including concurrent reviews, appeals, and denial prevention.
  • Maintain accurate documentation of utilization review findings and recommendations.
  • Monitor resource utilization while supporting quality patient care and organizational goals.
  • Stay current with healthcare regulations, accreditation standards, and utilization management best practices.

Qualifications

Education

  • Graduate of an accredited School of Nursing.

Experience

  • Minimum 5 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Management experience.
  • Minimum 3 years of discharge planning experience in an acute care setting.
  • Experience in Case Management or Clinical Documentation Improvement is preferred.

Licensure & Certifications

  • Current, unrestricted Registered Nurse (RN) license in the State of Nevada.
  • Demonstrated proficiency with InterQual criteria and ability to successfully complete the InterQual examination.
  • Recent experience utilizing Milliman Care Guidelines (MCG).

Required Knowledge & Skills

  • Strong understanding of utilization review principles, payer guidelines, Medicare/Medicaid regulations, and accreditation standards.
  • Excellent clinical assessment and critical thinking skills.
  • Ability to interpret medical records and determine medical necessity.
  • Strong communication, collaboration, and interpersonal skills.
  • Proficiency in electronic medical records (EMR) and Microsoft Office applications.
  • Ability to prepare reports, analyze data, and communicate findings effectively.

Working Conditions

This position is primarily office-based within an acute care hospital environment and requires prolonged computer use, reviewing medical records, and frequent collaboration with clinical teams. Occasional weekend or shift work may be required based on operational needs.
- ST

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

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About LanceSoft

Sourced by ZipRecruiter

Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we're 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Herndon, VA, US

Year founded

2000

Social media

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