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Behavioral Health Utilization Review Jobs in Silver Spring, MD

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

About the Job Candidate must have acute care Utilization Review experience. Candidate must live in ... Educates members of health care team through in-services staff meetings orientation and formal ...

Ascension

Registered Nurse Utilization Review

Baltimore, MD · On-site

$81K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options * Financial security & retirement: employer-matched 403(b), planning and hardship resources ...

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Showing results 21-40

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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 Aug 17, 2026, the average hourly pay for behavioral health utilization review in Silver Spring, MD is $43.71, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $50.19 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 popular job titles related to Behavioral Health Utilization Review jobs in Silver Spring, MD?

For Behavioral Health Utilization Review jobs in Silver Spring, MD, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Review jobs in Silver Spring, MD look for?

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What cities near Silver Spring, MD are hiring for Behavioral Health Utilization Review jobs?

Cities near Silver Spring, MD 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 Silver Spring, MD as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 19% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $90,917 per year, or $43.7 per hour.

Utilization Review Specialist (BCBA Licensee)

System One

Baltimore, MD • Remote

$51/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 24 days ago

Job description

Job Title: Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote – offsite) Type: Contract To Hire Compensation: $51/hr (W2) Work Model: 100% Remote Must be Licensed in one of the 3 states: MD, VA or Washington D.C.

Overview Utilizing key principles of utilization management, the Utilization Review Specialist (BCBA Licensee) performs prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of Applied Behavior Analysis (ABA) services. This role leverages clinical expertise in behavior analysis and evidence-based ABA practices to evaluate treatment plans, service intensity, and clinical outcomes for individuals with Autism Spectrum Disorder (ASD) and other developmental or behavioral diagnoses.

Responsibilities

  • Perform prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of ABA services.
  • Review ABA treatment requests (initial, concurrent, and retrospective) for clinical appropriateness and benefit coverage.
  • Evaluate ABA treatment plans, goals, supervision models, requested service intensity, and progress/outcomes using behavior analytic principles and evidence-based practices.
  • Analyze clinical documentation, benefit plans, mandates, and medical/behavioral health policies to support determinations related to ABA services.
  • Determine medical necessity and appropriateness by referencing applicable regulatory mandates, contracts/benefit information, and clinical guidelines and policies.
  • Conduct research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within the field of behavior analysis.
  • Collaborate with internal clinical leadership (e.g., medical directors) and cross-functional partners (e.g., provider and member services) to support appropriate benefit application and case decision-making.
  • Coordinate as needed with internal partners and providers related to benefit determinations and case-related follow-up.
  • Make appropriate referrals and contacts as needed; support members and providers with alternative care options when appropriate.
  • Provide guidance to providers and internal teams regarding ABA best practices, documentation standards, and authorization requirements.
  • Develop and present educational materials on ABA topics, treatment trends, and case learnings to internal stakeholders.

Requirements

  • Master’s Degree or higher in Behavior Analysis, Psychology, Education, or a related field
  • Board Certified Behavior Analyst (BCBA) certification — active and in good standing
  • Active state licensure as a Behavior Analyst (if required in the practicing state) — required where applicable
  • 3–5+ years of clinical ABA experience
  • Direct patient care experience delivering ABA services (e.g., in-home, center-based, school-based, community)
  • Demonstrated experience developing ABA treatment plans, including:
    • Functional behavior assessment/analysis (FBA/FA) and clinical documentation
    • Individualized goal development and measurement strategies
    • Treatment plan updates based on data and clinical progress
    • Caregiver training and/or supervision/model oversight (as applicable)
  • Strong written and interpersonal communication skills; ability to communicate effectively with providers and internal stakeholders
  • Strong clinical assessment and analytical skills with the ability to make sound, timely determinations
  • Ability to manage competing priorities and maintain organization in a fast-paced environment
  • Proficiency with web-based tools and Microsoft Office (Word, Excel, PowerPoint)

Preferred Qualifications

  • Prior experience in utilization management, care management, or payer-side review of ABA services
  • Working knowledge of managed care and health delivery systems
  • Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards)
  • Comfort working in a web-based systems environment and using online resources to support clinical review decisions

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1