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Behavioral Health Utilization Management Jobs (NOW HIRING)

MUSC

... Health-28 Scheduled Weekly Hours 40 Work Shift Conducts utilization reviews to determine if ... One year of case management and/or utilization management work experience preferred. Staff hired ...

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Behavioral Health Utilization Management information

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

As of Jun 8, 2026, the average hourly pay for behavioral health utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.
More about Behavioral Health Utilization Management jobs
What cities are hiring for Behavioral Health Utilization Management jobs? Cities with the most Behavioral Health Utilization Management job openings:
What states have the most Behavioral Health Utilization Management jobs? States with the most job openings for Behavioral Health Utilization Management jobs include:
What job categories do people searching Behavioral Health Utilization Management jobs look for? The top searched job categories for Behavioral Health Utilization Management jobs are:
Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in the United States as of May 2026, with employment types broken down into 79% Full Time, and 21% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Nurse Practitioner, Behavioral Health UM (PMHNP)

Nurse Practitioner, Behavioral Health UM (PMHNP)

Molina Healthcare

Long Beach, CA

$111K - $152K/yr

Full-time

Posted 6 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

145th of 260 rated insurance

Job description

Job Description

Job Summary

Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of clinical decision-making across markets. Participates in a team-based, physician-led model that aligns with national clinical oversight standards and enterprise behavioral health initiatives. Contributes to overarching strategy to provide quality and cost-effective member care.

 
Job Duties
  • Performs Behavioral Health utilization management reviews for inpatient, outpatient, and intermediate-level services using nationally recognized criteria (e.g., MCG, InterQual, ASAM).
  • Reviews medical documentation to determine the medical necessity, level of care, and continued stay appropriateness for behavioral health services.
  • Collaborates with Behavioral Health Medical Directors on complex or borderline cases, ensuring consistent application of criteria and alignment with regulatory standards.
  • Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate.
  • Maintains compliance with federal, state, and accreditation requirements (e.g., NCQA, URAC, CMS).
  • Participates in UM quality audits, internal case reviews, and peer-to-peer education.
  • Supports process improvement initiatives and contributes to the development of clinical review guidelines and training materials.
  • Works under the medical direction and supervision of a licensed physician, consistent with state law and corporate policy.
  • Obtains and maintains multi-state licensure to support national coverage needs.
  • Participates in enterprise Behavioral Health workgroups, SAIs, and other cross-functional initiatives as assigned.
  • Provides input to leadership regarding UM workflow optimization and emerging utilization trends.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • Master's degree in Psychiatric-Mental Health Nursing from an accredited program.
  • Completion of a Psychiatric-Mental Health Nurse Practitioner program at the master's level with current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC).
  • Minimum 3 years of experience as a Nurse Practitioner, ideally in managed care, behavioral health, or utilization management.
  • Demonstrated experience in the application of medical necessity criteria and regulatory guidelines.
  • Active, unrestricted state license in SC to practice as a PMHNP, with the ability to obtain cross-state licensure as required.
PREFERRED QUALIFICATIONS:
  • Prior experience in a managed care organization or payer-based utilization management setting.
  • Familiarity with Medicaid, Marketplace, and Medicare behavioral health regulations.
  • Strong working knowledge of clinical criteria (e.g., ASAM, MCG, InterQual).
  • Computer proficiency and experience with electronic medical record or UM systems.
  •  
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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