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Behavioral Health Utilization Review Nurse Jobs (NOW HIRING)

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 ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

Netsmart

Utilization Review Nurse

Utilization Review Nurse Responsible for utilization review work for emergency admissions and ... of healthcare resources * Participate in telephonic discussions with emergency department ...

New

University of Utah

Utilization Review Nurse

University of Utah Health seeks staff that are committed to the values of compassion, collaboration ... utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License? About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Joint Commission Accredited Health care Organizations standards, state statutes governing hospital ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... CONTINUUM OF CARE Benefits for You At Silver Cross Hospital, we care about your health and well ...

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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 Aug 12, 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.

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.

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.
More about Behavioral Health Utilization Review Nurse jobs
What cities are hiring for Behavioral Health Utilization Review Nurse jobs? 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:
What job categories do people searching Behavioral Health Utilization Review Nurse jobs look for? 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 89% Full Time, and 11% Part Time. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Oscar Health

Dallas, TX • Remote

$35 - $45.94/hr

Full-time

Posted 20 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

252nd of 304 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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