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Behavioral Health Utilization Review Jobs in Raleigh, NC

Duke Health

Utilization Manager

Durham, NC · On-site

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Duke Health

Utilization Manager

Durham, NC

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Duke University

Utilization Manager

Durham, NC · On-site

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Duke University

Utilization Manager

Durham, NC

Provides formal and informal education to physicians and the healthcare team to improve processes and outcomes related to utilization review and compliance with utilization management plan. * Gives ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... review agencies. Duties and Responsibilities * Monitor daily census and assignment to assure all ...

Duke Health

Behavioral Health Case Manager

Durham, NC · On-site

Ensure optimum utilization of the patient's and the Health System's resources and perform these ... review agencies. Duties and Responsibilities * Monitor daily census and assignment to assure all ...

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All JobsBehavioral Health Utilization Review JobsBehavioral Health Utilization Review Jobs in Raleigh, NC

Behavioral Health Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Jul 17, 2026, the average hourly pay for behavioral health utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

What is a Behavioral Health Utilization Review job?

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 the Behavioral Health Utilization Review position, 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 Raleigh, NC? The most popular types of Behavioral Health Utilization Review jobs in Raleigh, NC are:
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What job categories do people searching Behavioral Health Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Behavioral Health Utilization Review jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Behavioral Health Utilization Review jobs? Cities near Raleigh, NC 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 Raleigh, NC as of July 2026, with employment types broken down into 2% As Needed, 72% Full Time, 20% Part Time, 1% Temporary, and 5% Contract. Highlights an 94% Physical, 3% Hybrid, and 3% Remote job distribution, with an average salary of $85,486 per year, or $41.1 per hour.
Utilization Review Nurse

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Other

Re-posted 27 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Position Summary:
Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.
Qualifications:
North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.

What Granville Health System employees say

Pay

Hours and flexibility

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