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Behavioral Health Utilization Management Jobs in Riverside, CA

Aroha Technologies

Medical Case Manager

Orange, CA · On-site

$43.66 - $69.86/hr

... join the Behavioral Health Utilization Management (BHI - BH Utilization Management) team in Orange, CA. This position is responsible for reviewing medical service requests, determining medical ...

Dragonfly Recruiting

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Utilization Management Inpatient Coordinator

Orange, CA · Remote

$23 - $26/hr

Utilization Management Coordinator - Inpatient Review (Health Plan) Remote | Contract-to-Permanent Hire | Medicare Advantage We are seeking an experienced Utilization Management Coordinator ...

Pacific Grove

Utilization Specialist PRN

Riverside, CA

$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.

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Behavioral Health Utilization Management information

See Riverside, CA salary details

$22

$44

$71

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

As of Jun 11, 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 some common challenges faced by Behavioral Health Utilization Management professionals, and how are they typically 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 are the key skills and qualifications needed to thrive as a Behavioral Health Utilization Management professional, and why are they important?

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 June 2026, with employment types broken down into 65% Full Time, and 35% Part Time. Highlights an 100% In-person job distribution, with an average salary of $91,752 per year, or $44.1 per hour.
Medical Case Manager

Medical Case Manager

Aroha Technologies

Orange, CA • On-site

$43.66 - $69.86/hr

Contractor

Posted 26 days ago

Job description

#LPN2025
Job Title: Medical Case Manager

Location: Orange, CA 92868
Schedule: Monday – Friday | 8:00 AM – 5:00 PM (Full Office)
Salary Range: $90,820 – $145,312 annually ($43.66 – $69.86 per hour)
 

Position Summary

We are currently seeking a dedicated and experienced Medical Case Manager on behalf of CalOptima Health to join the Behavioral Health Utilization Management (BHI - BH Utilization Management) team in Orange, CA.

This position is responsible for reviewing medical service requests, determining medical necessity using established clinical criteria, coordinating care activities, and ensuring high-quality, member-focused service delivery. The ideal candidate will bring strong clinical expertise, utilization management experience, and the ability to thrive in a fast-paced healthcare environment.

Key ResponsibilitiesUtilization Management Services (85%)

  • Review inpatient and outpatient authorization requests for medical necessity using established clinical guidelines.

  • Screen cases for Medical Director review and communicate final determinations to providers and members.

  • Prepare and distribute decision notifications in compliance with regulatory standards.

  • Complete accurate documentation and data entry in the utilization management system.

  • Review ICD-10, CPT-4, and HCPCS codes for accuracy and appropriate coverage determination.

  • Coordinate Transition Care Management (TCM) activities.

  • Identify and report complaints and potential over/under-utilization issues.

  • Collaborate with internal teams and health networks to support enrollment and service coordination.

Administrative Support (10%)

  • Assist leadership in identifying staff training needs.

  • Maintain updated data resources and comply with tracking protocols and reporting requirements.

Other Duties (5%)

  • Perform additional projects and responsibilities as assigned.

Minimum Qualifications

  • Current California unrestricted license (LCSW, LPCC, LMFT, or RN).

  • Minimum three (3) years of clinical experience.

  • Utilization Management Reviewer experience required.

  • An equivalent combination of education and experience may be considered.

Preferred Qualifications

  • Managed care experience.

  • Behavioral health clinical experience.

Knowledge & Skills

  • Strong analytical and problem-solving abilities.

  • Ability to work independently and exercise sound clinical judgment.

  • Excellent written and verbal communication skills.

  • Strong organizational and multitasking abilities in a fast-paced environment.

  • Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint) and utilization management systems.

  • Ability to build effective professional relationships with diverse internal and external stakeholders.

Work Environment

This is a full office-based position located in Orange, CA 92868. Work is primarily sedentary in an indoor office setting with moderate noise levels. Occasional travel or schedule flexibility may be required depending on departmental needs.

Physical Requirements

  • Ability to sit for extended periods and work at a computer.

  • Clear verbal communication via phone and in-person interactions.

  • Manual dexterity for typing and documentation.

  • Ability to lift 10–25 pounds if required.

Apply Today

If you are a licensed clinical professional with utilization management experience seeking a stable, mission-driven opportunity in Orange County, we encourage you to apply.

Ashu
Team Lead – Healthcare Recruitment
Direct: 510-455-4427
Aroha Technologies Inc.
www.arohatechnologies.com