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Behavioral Health Utilization Review Jobs in Virginia

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... behavioral or mental health, or other related health field required. • Two or more years of ...

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

As of Aug 6, 2026, the average hourly pay for behavioral health utilization review in Virginia is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 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 Virginia? The most popular types of Behavioral Health Utilization Review jobs in Virginia are:
What are popular job titles related to Behavioral Health Utilization Review jobs in Virginia? For Behavioral Health Utilization Review jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Behavioral Health Utilization Review jobs in Virginia look for? The top searched job categories for Behavioral Health Utilization Review jobs in Virginia are:
What cities in Virginia are hiring for Behavioral Health Utilization Review jobs? Cities in Virginia 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 Virginia as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

Behavioral Healthcare Utilization Review Spec

Horizon Behavioral Heal

Lynchburg, VA • On-site

$46K - $74K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Hours: full-time (37.5 hours per week)

Location: Lynchburg VA, 24501

Compensation dependent on experience


Position Summary

The Behavioral Healthcare Utilization Review Specialist works on-site, and will proactively monitor utilization of services for clients, reviewing for quality of services and medical necessity. The employee will review clients’ medical records to ensure appropriate utilization of treatment resources, medical necessity, proper documentation, and compliance with federal and state regulations, and certification requirements of insurance plans or other managed care organizations (MCOs). This position will report to the CQI Manager.

Education Requirements

  • Bachelor's degree from an accredited college/university in an applicable human services field. Preferred: Master’s degree in social work, Mental Health Counseling, or related health field preferred.

Types of Experience

  • (2) Two years of continuous quality improvement and/or utilization review experience. Preference will be given to individual with at least one year of managed care experience. Behavioral Health experience is desirable.
  • An equivalent combination of education and experience that provides the candidate with the required knowledge, skills and abilities may be considered.

Related Knowledge, Skills and Abilities

  • Knowledge of behavioral healthcare terminology, the course and progress of substance abuse treatment and medical terminology;
  • Knowledge of Medicaid and MCO regulations and policies, relevant to behavioral healthcare and substance use;
  • Knowledge of Utilization Review protocols and auditing skills;
  • Knowledge of DSM 5, CPT Codes and ICD 10;
  • Knowledge of levels of care and medical necessity;
  • Ability to review and understand medical records, treatment plans and progress notes;
  • Proficiency in MS Office software and EMR systems;
  • Ability to extract and analyze data;
  • Ability to develop and present statistical and narrative reports;
  • Must be proficient in MS Office software and EMR systems.
  • Able to collaborate with all members of clinical team/medical providers;
  • Excellent verbal and written communication skills;
  • Ability to work independently as well as with a team;
  • Excellent organizational and time management skills;
  • Willing and available to work modified schedules (weekends, holiday, etc.) as required;
  • Ability to drive and must possess a valid driver's license. May be required to travel to different Horizon worksites during the day based on operational needs or provide admin support at other locations. Regular attendance at trainings and Horizon meetings may require travel to a variety of Horizon sites.

THE BEST BENEFITS FOR THOSE WHO TAKE CARE OF THE COMMUNITY

We’re proud to offer some of the best benefits options in Central Virginia. Participation in the Virginia Retirement System (VRS) is exclusively for public service workers in Virginia, while several options exist for life, health, dental, and vision insurance. Emphasis on work-life balance means a generous annual leave policy ensuring time for wellness with separate time allocated for sick leave and additionally for paid holidays. Stay active with Horizon’s annual wellness programs and various opportunities to interact with the community through the year. Horizon’s clinical sites are NHSC/HRSA approved for clinical student loan repayment and qualify for both the Public Service Loan Forgiveness (PSLF) and the Behavioral Health State Loan Repayment (BHLRP) programs. If you are interested in continuing your education, working at Horizon qualifies you to receive discounts at some local universities.

To Apply – Please visit our online career center at https://www.horizonbh.org/careers/

Horizon Behavioral Health is an Equal Opportunity Employer (EOE).