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Behavioral Health Utilization Review Jobs (NOW HIRING)

UHS

Utilization Reviewer -Behavioral Health

Conway, SC · On-site

Responsibilities Utilization Reviewer Opportunity! Lighthouse Behavioral Health Hospital, located ... Review clinical content of medical records, participate in treatment team meetings, and collaborate ...

UHS

Utilization Reviewer -Behavioral Health

Conway, SC · On-site

Responsibilities Utilization Reviewer Opportunity! Lighthouse Behavioral Health Hospital, located ... Review clinical content of medical records, participate in treatment team meetings, and collaborate ...

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

As of Jun 14, 2026, the average hourly pay for behavioral health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

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Behavioral Health Utilization Review jobs near you
Infographic showing various Behavioral Health Utilization Review job openings in the United States as of June 2026, with employment types broken down into 12% As Needed, 28% Full Time, 4% Part Time, 2% Temporary, and 54% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Behavioral Health Utilization Management Reviewer

Behavioral Health Utilization Management Reviewer

AmeriHealth Caritas Health Plan

Remote

Full-time

Medical, Retirement, PTO

Posted 21 days ago

AmeriHealth Caritas rating

8.5

Company rating: 8.5 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

87th of 261 rated insurance

Job description

Role Overview
Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification. The BH UM Reviewer will use professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases to integrated care management as needed. The BH UM Reviewer will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible to ensure that treatment delivered is appropriately utilized and meets the member's needs in the least restrictive, least intrusive manner possible. The BH UM Reviewer will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.
Work Arrangement
  • Remote role
  • Monday through Friday from 8:00 AM EST to 5:00 PM EST
  • Must work 4 out of 10 recognized company holidays to include Thanksgiving and Christmas (rotating)
  • Must be willing to work 2 to 3 weekends per year. Weekend rotation based on business needs

Education & Experience
  • Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing preferred
  • Licensed Social Worker candidates: Master Degree in Social Work required
  • Minimum of 2 years of independent clinical practice experience assessing and treating individuals with substance use/co-occurring disorders in a clinical setting
  • Utilization management experience in a managed care organization preferred
  • Experience working in a remote work environment preferred

Licensure
  • Requirements for LSW: Active and unencumbered professional licensure/independent licensure in Ohio: LPC, LCSW, LICSW, LISW, LCMHC, LMFT
    • Must have ability to obtain additional licensure in LA, NC, NH and DC within 12 months from date of hire
  • Requirements for RN: Active and unencumbered RN license in Ohio and/or compact state nurse license
    • Must have ability to obtain additional licensure in LA, NC, NH and DC within 12 months from date of hire

Skills & Abilities
  • Proficiency in Microsoft Office, including Word, Excel, Teams, and Outlook
  • Consistent and accurate typing skills
  • Ability to communicate in a positive/professional manner both orally and written
  • Strong problem-solving skills and decision making skills
  • Strong organizational and time management skills
  • Ability to follow detailed instructions with a high degree of accuracy
  • Ability to work independently; complete tasks in the allotted time frame

Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

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