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Behavioral Health Utilization Review Jobs in Ohio

Southwest General

UTILIZATION SPECIALIST

Hudson, OH

... 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-E.D.

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-E.D.

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

As of Sep 6, 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.

UTILIZATION SPECIALIST

Southwest General

Hudson, OH

Per diem

Re-posted 7 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

  • POSITION INFORMATION
    • Position summary:
      • The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patient’s plan of care. The Utilization Specialist’s responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Graduation from an accredited School of Nursing. BSN graduate preferred.

    • Required length and type of experience:
      • Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
      • Previous Care Management, Case Management or Utilization Management Experience preferred
      • Previous experience with screening criteria (i.e. Interqual, MCG) preferred
      • Excellent critical thinking and communication skills
      • Strong computer skills

    • Required licensure, certification or registry:
      • Current licensure by Ohio State Board of Nursing.
      • ACM/CCM Certification helpful

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