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Behavioral Health Utilization Review Nurse Jobs (NOW HIRING)

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

... nursing experience * Experience in Care Coordination, Utilization Review, and Discharge Planning ... Equal Employment Opportunity Pride Health is an equal opportunity employer. We do not discriminate ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Utilization Review Nurse . Under the direction of the Director of Utilization Management. Website ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Utilization Review Nurse . Under the direction of the Director of Utilization Management. Website ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

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Behavioral Health Utilization Review Nurse information

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

As of Sep 5, 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.

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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 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

900 Emory Healthcare

Warner Robins, GA • On-site

$90 - $110/hr

Other

Posted 4 days ago

Job description

Work Shift

The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The Utilization Reviewer serves as a resource to medical and hospital staff on utilization and regulatory issues and participates in coordination of individualized patient care services. The Utilization Reviewer plays an integral role in discharge planning and maximizing the continuum of care for patients assigned to his/her assigned unit. The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for the patient.

Qualifications
  • Education & Training: Graduate of an accredited School of Nursing.
  • Experience: Three (3) years in an acute care setting.
  • Required Certification/Registration/Licensure: Current US state RN license with authorization to practice in the state of GA.

Knowledge, Skills & Abilities: Utilizes a variety of standard office equipment to include computer, printer, fax machine, copier, telephone etc. Basic knowledge of statistics encouraged.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request.

Scheduled Weekly Hours: 40 FTE: 1 Expanded Work Shift: On Call:

Please note that one week's advance notice is preferred.

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