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Behavioral Health Utilization Management Jobs in Raleigh, NC

Duke Health

Utilization Manager

Durham, NC · On-site

Complies with current rules and regulatory requirements pertaining to utilization management. Initiates actions to obtain appropriate determinations. Collaborates with members of the healthcare team ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Work with Utilization Management partners to provide information and feedback that will enhance ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of ... Work with Utilization Management partners to provide information and feedback that will enhance ...

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Behavioral Health Utilization Management information

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$41

$67

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

As of Sep 14, 2026, the average hourly pay for behavioral health utilization management 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.

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 Raleigh, NC?

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

What job categories do people searching Behavioral Health Utilization Management jobs in Raleigh, NC look for?

The top searched job categories for Behavioral Health Utilization Management jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Behavioral Health Utilization Management jobs?

Cities near Raleigh, NC 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 Raleigh, NC as of September 2026, with employment types broken down into 2% As Needed, 72% Full Time, 18% Part Time, and 8% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Nurse

Chapel Hill, NC • On-site

Brighton Health Plan Solutions
201 - 500 employees
Learn more about Brighton Health Plan Solutionsexternal

Other

This job post has expired today. Applications are no longer accepted.

Job description

About The Role

BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.

Primary Responsibilities

•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.

•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.

•    Collaborates with healthcare partners to ensure timely review of services and care.

•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.

•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards

•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.

•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.

•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.

•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.

•    Duties as assigned.

Essential Qualifications

•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.

•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)

•    Must be able to work independently.

•    Must be detail oriented and have strong organizational and time management skills.

•    Adaptive to a high pace and changing environment- flexibility in assignment.

•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.

•    Proficient in MCG and CMS criteria sets

•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.

•    Working knowledge of URAC and NCQA.

•   2+ years’ experience in a UM team within managed care setting.

•   3+ years’ experience in clinical nurse setting preferred.

•   TPA Experience preferred.

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