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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

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 University

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 University

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 ...

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All JobsBehavioral Health Utilization Management JobsBehavioral Health Utilization Management Jobs in Raleigh, NC

Behavioral Health Utilization Management information

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$20

$41

$67

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

As of Aug 11, 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 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.
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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 August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Director - Utilization Management, Physical Health

Jobtailor

Morrisville, NC • On-site

$110 - $150/hr

Other

Posted 5 days ago

Job description

Responsibilities
  • Administer and coordinate physical health utilization management activities
  • Ensure the UM Department operates as an integrated department
  • Oversee the correct level and intensity of services for individuals
  • Manage and develop staff to maintain a qualified workforce
  • Collaborate with the Director of Behavioral Health Utilization Management
Requirements
  • Bachelors in Nursing with 7 years' post-degree experience
  • At least 2 years of supervisory experience
  • At least 2 years Utilization Management experience or substantially equivalent experience
  • Master's degree in Nursing and 5 years' experience including 2 years of supervisory experience and UM experience or equivalent experience
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