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Behavioral Health Utilization Review Jobs in Ohio

New Vista Behavioral Health

UM Coordinator

Cincinnati, OH · On-site

$18 - $24/hr

Position Summary The Utilization Management (UM) Coordinator supports the facility's utilization review and authorization processes for patients receiving mental health and behavioral health services.

Integrated Resources INC

Care Review Nurse

Columbus, OH · On-site

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... health care delivery in the most cost-effective manner. The Utilization Specialist must be able to ... The Utilization Specialist's responsibility is to collect data and clinical review summaries on ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... health care delivery in the most cost-effective manner. The Utilization Specialist must be able to ... The Utilization Specialist's responsibility is to collect data and clinical review summaries on ...

Southwest General

UTILIZATION SPECIALIST

Hudson, OH · On-site

... health care delivery in the most cost-effective manner. The Utilization Specialist must be able to ... The Utilization Specialist's responsibility is to collect data and clinical review summaries on ...

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All JobsBehavioral Health Utilization Review JobsBehavioral Health Utilization Review Jobs in Ohio

Behavioral Health Utilization Review information

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

As of Sep 5, 2026, the average hourly pay for behavioral health utilization review in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 per hour, depending on experience, location, and employer.

What is a behavioral health utilization review?

A Behavioral Health Utilization Review (UR) job involves assessing the medical necessity, appropriateness, and efficiency of mental health and substance use disorder treatments. UR professionals review clinical documentation, apply insurance guidelines, and collaborate with providers to ensure patients receive appropriate care while ensuring compliance with policies and regulations. They help manage healthcare costs by preventing unnecessary services while advocating for necessary treatments. This role is common in insurance companies, hospitals, and managed care organizations. Strong knowledge of behavioral health guidelines and communication skills are essential for success.

What types of teams do behavioral health utilization review professionals typically work with, and how do they collaborate across departments?

Behavioral Health Utilization Review professionals frequently work within multidisciplinary teams that may include clinicians, case managers, claims specialists, and provider relations staff. Collaboration involves regularly reviewing patient records, discussing complex cases, and communicating with both internal and external healthcare providers to ensure appropriate levels of care are authorized. This role often requires coordination across departments to resolve authorization issues, clarify clinical information, and meet regulatory requirements. Effective teamwork is key to maintaining efficient workflows, supporting patient outcomes, and ensuring compliance with payer policies.

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

To thrive in Behavioral Health Utilization Review, you typically need a clinical background in mental health or nursing, strong analytical abilities, and knowledge of insurance guidelines. Familiarity with medical coding, utilization management software (such as InterQual or MCG), and current behavioral health regulations is highly valued, and licensure (RN, LCSW, LPC, or similar) is often required. Attention to detail, critical thinking, effective communication, and strong organizational skills set top candidates apart. These competencies ensure accurate evaluation of medical necessity, efficient authorization processes, and collaboration with providers for optimal patient care.

What are the most commonly searched types of Behavioral Health Utilization Review jobs in Ohio?

The most popular types of Behavioral Health Utilization Review jobs in Ohio are:

What are popular job titles related to Behavioral Health Utilization Review jobs in Ohio?

For Behavioral Health Utilization Review jobs in Ohio, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Review jobs in Ohio look for?

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

What cities in Ohio are hiring for Behavioral Health Utilization Review jobs?

Cities in Ohio with the most Behavioral Health Utilization Review job openings:

Behavioral Health Utilization Review jobs near you
Infographic showing various Behavioral Health Utilization Review job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 16% Part Time, 1% Temporary, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

MANAGER OF UTILIZATION REVIEW

Southwest General

Cleveland, OH

Full-time

Posted 4 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

544th of 1,065 rated hospitals

Job description

Summary

  • POSITION INFORMATION
    • Position summary:
      • The Utilization Management (UM) RN Manager is responsible for the day-to-day leadership, operational oversight, and performance management of the Utilization Management nursing team. Reporting to the UM RN Director, the Manager translates department strategy, regulatory and payer requirements, approved clinical review criteria, and organizational priorities into consistent daily execution.
      • The role provides direct supervision, coaching, workflow management, clinical-operational support, and performance oversight for assigned UM staff. The Manager collaborates with physician advisors/medical directors, case management, clinical operations, revenue cycle, payer relations, quality, compliance, and other stakeholders to support timely, accurate, evidence-informed utilization management decisions and appropriate stewardship of healthcare resources.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelor of Science in Nursing (BSN) required, or equivalent qualification consistent with organizational policy.
      • Masters degree in Nursing, Healthcare Administration, Business Administration, Public Health, or a related field preferred.

    • Required length and type of experience:
      • Five or more years of progressive clinical nursing and/or utilization management experience preferred, including three or more years of experience in utilization management, utilization review, case management, managed care, or a closely related function.
      • Prior formal leadership experience required; two or more years of supervisory or management experience preferred.

    • Required licensure, certification or registry:
      • Current Ohio State Board of Nursing license required.
      • Certified Case Manager (CCM) certification preferred.
      • Accredited Case Manager (ACM) certification preferred.
    • Core Knowledge, Skills, and Competencies
      • Knowledge of utilization management and utilization review principles, including prospective, concurrent, and retrospective review.
      • Knowledge of medical necessity, patient status, level-of-care review, authorization processes, payer requirements, denial prevention, and escalation pathways.
      • Knowledge of evidence-based clinical review criteria and appropriate use of clinical decision-support tools.
      • Knowledge of regulatory and accreditation requirements affecting utilization management and clinical review.
      • Demonstrated ability in people leadership, coaching, performance management, conflict resolution, and change management.
      • Demonstrated ability to interpret operational analytics and KPIs, conduct root-cause analysis, and drive process improvement.
      • Demonstrated ability to communicate effectively across interdisciplinary teams, including nursing, physicians, physician advisors, payers, revenue cycle, and leadership.
      • Demonstrated application of professional nursing judgment, ethical practice, confidentiality, and appropriate stewardship of healthcare resources.

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