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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 · 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 ...

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Behavioral Health Utilization Review information

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

As of Jul 28, 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, 76% Full Time, 17% Part Time, and 5% Contract. Highlights an 95% Physical, 2% Hybrid, and 3% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.
Utilization Review Specialist (Remote)

Utilization Review Specialist (Remote)

Coronis Health

Chapel Hill, NC • On-site

$60K - $62K/yr

Full-time, Part-time

Posted 5 days ago

Coronis Health rating

7.7

Company rating: 7.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

168th of 488 rated business services

Job description

Title: Utilization Review Specialist/Behavioral Health Substance Abuse (Remote)
Reports to: UR Manager
FLSA Classification: Exempt
Full-Time or Part-Time: Full-Time
Salary Range: $60,000 to $62,000
Starting pay varies based on location and experience, in compliance with specific state wage regulations. Competitive rates tailored to your geography and expertise.

Position Overview:
The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The role involves providing appropriate client information to third-party payers regarding the medical necessity of treatment in a timely manner. The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews, and appeal reviews as needed.

Key Responsibilities:

  1. Act as the agency liaison with insurance and managed care companies for the authorization of treatment costs, representing the company in a positive and professional manner.
  2. Participate in staff meetings as needed.
  3. Ensure clear communication with supervisors, co-workers, and facilities.
  4. Keep abreast of changes and monitor compliance with State and Federal laws and regulations in areas of insurance and third-party payers.
  5. Protect the confidentiality of patients and the privacy of staff.
  6. Use a computer to type correspondence, reports, and other items as requested, ensuring accuracy.
  7. Process data in conjunction with a compliance consultant to present it effectively using established statistical methods.
  8. Demonstrate the willingness to accept responsibility.
  9. Perform other duties as assigned by the Director of Utilization Review.

Qualifications:

Minimum Education/Certifications/OTJ Experience:

  • BA in Psychology or a related field.
  • Three to five (5) years of experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, Case Manager, or Utilization Review Coordinator).

Knowledge of Subject Matter:

  • Prior Utilization Review experience in a Substance Abuse environment is mandatory.
  • Knowledge of ASAM guidelines.
  • Knowledge of medical terminology.
  • Knowledge of State and Federal Statutes regarding patient confidentiality laws.
  • Knowledge of Drug-Free Workplace Policies, Corporate Integrity, and Compliance Programs.
  • Knowledge of state guidelines and accreditation agency standards.

Skills:

  • Ability to establish rapport and supervise employees and professional staff.
  • Ability to work under stressful conditions and be flexible in relation to department needs.
  • Demonstrates proficiency in verbal and written communication skills.
  • KIPU experience required; Best Notes experience is a plus.

Abilities/Attributes:

  • Demonstrates willingness to accept responsibility and perform tasks with minimal supervision.

Additional Information:
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.
Coronis Health is committed to creating a diverse and inclusive environment where all employees are treated fairly and with respect. We are an equal-opportunity employer, providing equal opportunities to all applicants and employees regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected characteristic. We welcome and encourage applications from candidates of all backgrounds.


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