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Behavioral Health Utilization Management Jobs in Riverside, CA

Pacific Grove

Utilization Specialist PRN

Riverside, CA · On-site

$31 - $50/hr

Overview Pacific Grove Hospital in Riverside, CA., is a leader in behavioral healthcare, providing ... Act as liaison between managed care organizations and the facility professional clinical staff.

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... in a health plan medical management documentation system a plus * Extremely proficient with ...

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All JobsBehavioral Health Utilization Management JobsBehavioral Health Utilization Management Jobs in Riverside, CA

Behavioral Health Utilization Management information

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$22

$44

$71

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

As of Aug 15, 2026, the average hourly pay for behavioral health utilization management in Riverside, CA is $44.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.86 and $50.67 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 Riverside, CA?

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

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

The top searched job categories for Behavioral Health Utilization Management jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Behavioral Health Utilization Management jobs?

Cities near Riverside, CA 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 Riverside, CA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $91,752 per year, or $44.1 per hour.

Director of Utilization Management (Behavioral Health)

Nbutexas

Orange, CA • On-site

$100 - $130/hr

Other

Posted 3 days ago

New

Job description

An established behavioral health hospital is seeking a Director of Utilization Management to lead its Utilization Management program. This high-impact leadership role offers the chance to collaborate with respected clinical teams and make a meaningful difference in patient care, regulatory compliance, and reimbursement optimization.

Director of Utilization Management Benefits & Compensation
  • Competitive compensation and comprehensive benefits package
  • Executive-level position with organization-wide visibility
  • Opportunity to drive improvements in clinical and financial outcomes
  • Collaborative, supportive leadership culture
  • Stable, mission-driven organization committed to behavioral health
Director of Utilization Management Requirements & Qualifications
  • Current California RN license required
  • 5+ years of leadership experience in Utilization Management or Utilization Review
  • Experience in behavioral health, psychiatric hospital, or acute care settings
  • Strong knowledge of behavioral health utilization management, concurrent review, denial management, appeals, and reimbursement
  • Experience with Medi-Cal, Medicare, commercial payers, and California behavioral health regulations
  • Proven leadership, communication, and team development skills
Director of Utilization Management Preferred Background & Skills
  • Familiarity with Carelon Behavioral Health and Orange County behavioral health systems
Director of Utilization Management Day-to-Day Responsibilities
  • Lead all Utilization Management and Utilization Review operations
  • Supervise and develop Utilization Management and Social Services teams
  • Oversee concurrent review, payer authorizations, appeals, denial management, and reimbursement optimization
  • Ensure compliance with California regulations, Medi-Cal, Medicare, commercial payers, and accreditation standards
  • Collaborate with physicians, clinical leadership, and care teams to improve patient flow, length of stay, and discharge planning
  • Build and maintain relationships with managed care organizations, county agencies, and community providers
  • Monitor utilization trends, quality metrics, and financial performance to drive process improvements
  • Provide education and support to clinical staff on utilization management best practices

Join a respected leader in behavioral health and help shape the future of patient care through strategic leadership and partnership.

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