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Behavioral Health Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborative healthcare environment Apply Now If you have strong Utilization Review, InterQual ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

... suffer from behavioral health, substance use, and SDoH challenges. We use population health ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Collaborate with physicians, healthcare providers, claims professionals, and internal team members ...

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How much do behavioral health utilization review nurse jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for behavioral health utilization review nurse 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 a behavioral health utilization review nurse?

A Behavioral Health Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of mental health and substance use treatment services. They review clinical information, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their role helps ensure patients receive appropriate care while preventing unnecessary or excessive services, supporting both patient well-being and cost-effective care.

How does a behavioral health utilization review nurse typically collaborate with other healthcare professionals?

Behavioral Health Utilization Review Nurses frequently work with multidisciplinary teams that include physicians, therapists, social workers, and case managers. They are responsible for reviewing patient cases to ensure that treatment plans are appropriate and align with insurance guidelines, often requiring clear and timely communication with both providers and payers. Strong collaboration is essential, as these nurses provide clinical insights during case reviews and help coordinate care transitions or discharge planning. This teamwork ensures patients receive optimal care while also meeting utilization and regulatory standards.

What are the key skills and qualifications needed to thrive as a behavioral health utilization review nurse, and why are they important?

To thrive as a Behavioral Health Utilization Review Nurse, you need a strong background in psychiatric nursing, knowledge of mental health diagnoses, and an active RN license. Familiarity with utilization management software, electronic health records, and guidelines such as MCG or InterQual is typically required. Excellent critical thinking, attention to detail, and communication skills help in evaluating care plans and collaborating with providers. These competencies ensure appropriate care utilization, regulatory compliance, and optimal patient outcomes in behavioral health settings.

What is the difference between Behavioral Health Utilization Review Nurse vs Behavioral Health Case Manager?

AspectBehavioral Health Utilization Review NurseBehavioral Health Case Manager
Primary RoleReviews and approves behavioral health services for insurance coverageCoordinates and manages ongoing behavioral health treatment plans
Work EnvironmentInsurance companies, healthcare facilities, utilization review departmentsHospitals, outpatient clinics, community health organizations
CredentialsRN license, certification in utilization review preferredRN or social work degree, certification in case management often preferred

While both roles involve behavioral health, the Utilization Review Nurse focuses on evaluating and authorizing services for insurance purposes, whereas the Case Manager actively manages patient treatment plans and coordinates care. Understanding these differences helps in choosing the right career path or job search focus.

More about Behavioral Health Utilization Review Nurse jobs

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Cities with the most Behavioral Health Utilization Review Nurse job openings:

What states have the most Behavioral Health Utilization Review Nurse jobs?

States with the most job openings for Behavioral Health Utilization Review Nurse jobs include:

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The top searched job categories for Behavioral Health Utilization Review Nurse jobs are:

Behavioral Health Utilization Review Nurse jobs near you
Infographic showing various Behavioral Health Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 81% Full Time, 12% Part Time, 2% Temporary, and 5% Contract. Highlights an 79% In-person, 2% Hybrid, and 19% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Manager Utilization Management-Behavioral Health

Piedmont Healthcare Inc.

Atlanta, GA • On-site

Full-time

Posted 29 days ago

Piedmont Healthcare rating

7.1

Company rating: 7.1 out of 10

Based on 468 frontline employees who took The Breakroom Quiz

379th of 895 rated healthcare providers

Job description

Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance. Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations.
Education
  • Bachelors Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required
Work Experience
  • 5 years of experience in Behavioral Health Utilization Management and Utilization Review processes using medical necessity criteria (InterQual and/or Milliman).

  • 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting Required

  • Experience working in a system-level or multi-site environment Preferred
Licenses and Certifications
  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required or

  • LPC-Licensed Professional Counselor Required or

  • LMSW - Licensed Medical Social Worker - State Licensure Required or

  • LCSW- License Clinical Social Worker Required or

  • Licensed Marriage and Family Therapist (LMFT) Required

  • IQCI Certification Required

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