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Behavioral Health Utilization Management Jobs in Oklahoma

SSM Health

Behavioral Health Technician

Oklahoma City, OK · On-site

$15 - $18.50/hr

... on management of behavior and community living skills. Daily Pay : Get paid daily doing the work ... At SSM Health, we believe you deserve the flexibility to work a schedule that fits your life and to ...

SSM Health

Behavioral Health Technician

Oklahoma City, OK · On-site

$15 - $18.50/hr

Focus is on compassionate care, behavioral management, and rehabilitation for patients in ... At SSM Health, we believe you deserve the flexibility to work a schedule that fits your life and to ...

SSM Health

Behavioral Health Technician

Oklahoma City, OK · On-site

$15 - $18.50/hr

Focus is on compassionate care, behavioral management, and rehabilitation for patients in ... At SSM Health, we believe you deserve the flexibility to work a schedule that fits your life and to ...

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All JobsBehavioral Health Utilization Management JobsBehavioral Health Utilization Management Jobs in Oklahoma

Behavioral Health Utilization Management information

See Oklahoma salary details

$19

$39

$63

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

As of Aug 27, 2026, the average hourly pay for behavioral health utilization management in Oklahoma is $39.04, according to ZipRecruiter salary data. Most workers in this role earn between $30.87 and $44.86 per hour, depending on experience, location, and employer.

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 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 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 popular job titles related to Behavioral Health Utilization Management jobs in Oklahoma?

For Behavioral Health Utilization Management jobs in Oklahoma, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Management jobs in Oklahoma look for?

The top searched job categories for Behavioral Health Utilization Management jobs in Oklahoma are:

Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Oklahoma as of August 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $81,204 per year, or $39 per hour.

Medical Management - Senior Manager Clinical Governance and Performance

CommunityCare

Tulsa, OK • On-site

Other

Posted 24 days ago

Job description

WORK ARRANGEMENT:
Remote, with occasional travel as needed for meetings, audits, training, or other business requirements.
JOB SUMMARY:
Responsible for leading governance, audit readiness, training, policy and procedure management, corrective action oversight, and performance improvement across Physical Health Utilization Management, Behavioral Health Utilization Management, Pharmacy Utilization Management, and Appeals and Grievances.
Reporting to the Chief Medical Officer, the Director provides centralized leadership for internal and delegated entity auditing, continuous regulatory and accreditation readiness, corrective action monitoring, operational training, process standardization, and alignment of policies and procedures across the assigned functions.
Works closely with clinical and operational leaders to translate Medicare Advantage, Marketplace, state, accreditation, contractual, and organizational requirements into consistent and sustainable operational practices. Serves as the Chief Medical Officer's designated leader for governance and performance activities within the assigned areas and provides leadership to audit, training, administrative support, and process improvement staff.
KEY RESPONSIBILITIES:
  • Lead governance and performance activities across Physical Health UM, Behavioral Health UM, Pharmacy UM, and Appeals and Grievances.
  • Maintain continuous readiness for CMS, Marketplace, state, URAC, delegated oversight, contractual, and internal audits.
  • Develop and oversee risk-based internal and delegated entity audits, including operational and clinical reviews.
  • Establish standardized audit tools, sampling methods, scoring, documentation requirements, reporting, and escalation thresholds.
  • Analyze audit and monitoring results to identify trends, control gaps, training needs, repeat findings, and systemic risk.
  • Oversee corrective action plans, including root cause analysis, accountable owners, remediation timelines, effectiveness monitoring, and closure.
  • Escalate material findings, delayed remediation, repeat deficiencies, and delegate performance concerns to the Chief Medical Officer and appropriate leaders.
  • Oversee onboarding, annual, regulatory, remedial, and role-specific training and monitors completion, competency, and effectiveness.
  • Lead the development, alignment, implementation, and maintenance of policies, desk level procedures, and related operational documents.
  • Monitor regulatory and accreditation changes and coordinates updates to policies, procedures, training, audit tools, and operational practices.
  • Use audit findings, appeals and grievance trends, complaints, overturns, delegate performance, and operational data to identify improvement opportunities.
  • Lead process improvement initiatives and cross-functional workgroups addressing operational, regulatory, and performance concerns.
  • Develop reports and governance updates for the Chief Medical Officer, functional leaders, and applicable committees.
  • Partner with Compliance, Legal, Quality, Contracting, Credentialling, HR, and other departments as appropriate.
  • Provide leadership, performance oversight, and professional development for assigned audit, training, administrative support, and process improvement staff.
  • Perform other related job duties as required or assigned.
QUALIFICATIONS:
  • Demonstrated leadership ability within a health plan, managed care, or similarly regulated health care environment.
  • Strong knowledge of Medicare Advantage and Marketplace regulatory and operational requirements for a health plan.
  • Broad understanding of health plan operations, including utilization management, prior authorization, organization and coverage determinations, appeals, grievances, notices, delegation, and member and provider communications.
  • Demonstrated experience with continuous audit readiness, internal auditing, delegated entity oversight, corrective action planning, policy and procedure management, training, and performance improvement.
  • Ability to interpret complex regulatory, accreditation, contractual, and operational requirements and translate them into practical and sustainable processes.
  • Strong analytical skills with the ability to identify trends, systemic risks, control gaps, root causes, and improvement opportunities.
  • Ability to exercise authority and influence across multiple operational areas while maintaining collaborative relationships with functional leaders.
  • Ability to distinguish regulatory requirements from organizational policy, clinical judgment, and operational preference.
  • Well-developed written, verbal, interpersonal, facilitation, and presentation skills.
  • Strong organizational and project management skills with the ability to manage competing priorities and regulatory deadlines.
  • Ability to respectfully challenge existing practices, escalate concerns appropriately, and facilitate cross-functional resolutions.
  • Demonstrated sound judgment, integrity, accountability, professionalism, and discretion.
  • Successful completion of Health Care Sanctions background check.
  • Successful completion of pre-employment drug testing.
  • Ability to converse and write fluently in English.
EDUCATION/EXPERIENCE:
  • Bachelor's degree in health care administration, business administration, public health, nursing, compliance, pharmacy, quality, or a related field.
  • Minimum of five years of progressive experience in health plan operations, utilization management, appeals and grievances, regulatory operations, auditing, accreditation, delegated oversight, performance improvement, or a related function.
  • Minimum of three years of leadership or supervisory experience, including responsibility for staff performance, development, and accountability.
  • Demonstrated experience supporting or leading CMS, URAC, state, delegated entity, client, or internal audit activities.
  • Demonstrated experience developing or overseeing audit programs, corrective action plans, policies, procedures, training programs, or operational monitoring.
  • Experience with Medicare Advantage program audits, organization determinations, coverage determinations, appeals, grievances, reopening requirements, and delegated oversight strongly preferred.
  • Experience with Marketplace requirements and URAC accreditation audits strongly preferred.
  • Experience leading multidisciplinary teams or functions involving audit, training, policy management, administrative support, or process improvement preferred.
  • Advanced degree or certification in health care administration, compliance, quality, audit, project management, or process improvement preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

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