Morrisville, NC · On-site
$110 - $150/hr
Collaborate with the Director of Behavioral Health Utilization Management Requirements * Bachelors in Nursing with 7 years' post-degree experience * At least 2 years of supervisory experience * At ...
Morrisville, NC · On-site
$110 - $150/hr
Collaborate with the Director of Behavioral Health Utilization Management Requirements * Bachelors in Nursing with 7 years' post-degree experience * At least 2 years of supervisory experience * At ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Oxford, NC · On-site
One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization ...
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical ...
Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic ...
Quick apply
The Utilization Management Nurse performs medical necessity and benefit review requests in ... Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or ...
The Utilization Management Nurse performs medical necessity and benefit review requests in ... reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or ...
Chapel Hill, NC · On-site +1
The Utilization Management Nurse performs medical necessity and benefit review requests in ... reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
Case Manager - Utilization Review Location ... Granville Health System, Oxford NC About Granville Health System: For over a century, Granville ...
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Raleigh, NC · On-site
Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ... Prior experience in case management, home health, discharge planning, or Concurrent review.
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
Conduct utilization reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care ...
Conduct utilization reviews to monitor for over/under utilization Program Operation and Management * Identify high risk consumers and those with special health care needs for referral to Care ...
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 ...
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 ...
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 ...
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 ...
Morrisville, NC · On-site +1
$69K - $88K/yr
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ... Health and Behavioral Health Collaborate with other departments * Monitor for undesirable ...
Morrisville, NC · On-site +1
$69K - $88K/yr
Conduct utilization reviews to monitor adherence to clinical practice guidelines and best practice ... Health and Behavioral Health Collaborate with other departments * Monitor for undesirable ...
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ... review the education and awareness resources at HB531 | Florida Agency for Health Care ...
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 ...
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 ...
$20.80 - $25
2% of jobs
$25 - $29.21
9% of jobs
$32.09 is the 25th percentile. Wages below this are outliers.
$29.21 - $33.42
21% of jobs
The median wage is $36.82 / hr.
$33.42 - $37.62
23% of jobs
$37.62 - $41.83
13% of jobs
$45.10 is the 75th percentile. Wages above this are outliers.
$41.83 - $46.03
10% of jobs
$46.03 - $50.24
8% of jobs
$50.24 - $54.45
5% of jobs
$54.45 - $58.65
5% of jobs
$58.65 - $62.86
2% of jobs
$62.86 - $67.06
2% of jobs
$20
$41
$67
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.
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.
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.
$110 - $150/hr
Other
Posted 6 days ago
