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Behavioral Utilization Review Jobs in Raleigh, NC

Omega Solutions Inc

Pharmacist

Raleigh, NC · On-site

... Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physicians Administered Drug ...

North Carolina

Director of Psychiatry CPHC

Raleigh, NC · On-site

$340K/yr

... utilization review efforts. * Serves as a key liaison across custody, nursing, administrative, and behavioral health teams to align services, address grievances, manage referrals, and support ...

New

Adult Correction

Nurse Director

Raleigh, NC · On-site

$96 - $158/hr

The Nurse Director oversees inpatient medical and behavioral health nursing operations, urgent care, specialty clinics, perioperative services, Medical Records, and Utilization Review, while building ...

Posted today

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Behavioral Utilization Review information

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$20

$41

$67

How much do behavioral utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for behavioral 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 the difference between Behavioral Utilization Review vs Behavioral Case Manager?

AspectBehavioral Utilization ReviewBehavioral Case Manager
CredentialsLicensed mental health professionals, certifications varyLicensed clinical social workers, counselors, or therapists
Work EnvironmentReview settings, insurance companies, healthcare facilitiesDirect patient interaction, hospitals, outpatient clinics
Employer & IndustryInsurance companies, healthcare organizationsHospitals, mental health agencies, managed care
Primary FocusAssessing medical necessity, reviewing treatment plansCoordinating care, supporting treatment adherence

Behavioral Utilization Review primarily involves evaluating the necessity of mental health services through review processes, while Behavioral Case Managers focus on coordinating patient care and supporting treatment plans. Both roles require mental health credentials but differ in daily tasks and work settings.

How to become a behavioral utilization review?

To become a behavioral utilization review specialist, candidates typically need a bachelor's degree in psychology, social work, nursing, or a related field. Relevant experience in mental health or healthcare settings, along with knowledge of insurance policies and utilization review processes, is important; some roles may require certification such as the Certified Professional in Utilization Review (CPUR).

Is behavioral utilization review a stressful job?

Behavioral utilization review can be stressful due to the need to evaluate complex mental health cases, meet strict deadlines, and handle sensitive patient information. The role often requires strong attention to detail, critical thinking, and emotional resilience, which can contribute to job-related stress.

What are popular job titles related to Behavioral Utilization Review jobs in Raleigh, NC?

For Behavioral Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Behavioral Utilization Review jobs in Raleigh, NC look for?

The top searched job categories for Behavioral Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Behavioral Utilization Review jobs?

Cities near Raleigh, NC with the most Behavioral Utilization Review job openings:

Behavioral Utilization Review jobs near you
Infographic showing various Behavioral Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 91% Full Time, and 9% Part Time. Highlights an 100% In-person job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Review Specialist

Lifepoint Health

Raleigh, NC • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

LifePoint Health rating

5.9

Company rating: 5.9 out of 10

Based on 273 frontline employees who took The Breakroom Quiz

766th of 898 rated healthcare providers

Job description

Your experience matters

Lifepoint Behavioral Health is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. Triangle Springs is a 77-bed behavioral health hospital located in Raleigh, North Carolina, providing care for patients with mental health and substance use disorders. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Registered Nurse (RN) joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of stay and interfaces with managed care organizations, external reviewers and other payers. UR advocates on behalf of patients with substance abuse, dual diagnosis, psychiatric or emotional disorders to manage care providers for necessary treatment. UR contacts external case managers/managed care organizations for certification of insurance benefits throughout the patient's stay and assists the treatment team in understanding the insurance company's requirements for continued stay and discharge planning. 

Job Responsibilities  

  • Displays knowledge of clinical criteria, managed care requirements for inpatient and outpatient authorization and advocates on behalf of the patient to secure coverage for needed services
  • Complete pre and re-certifications for inpatient and outpatient services. Reports appropriate denial, and authorization information to designated resource.
  • Actively communicates with interdisciplinary team to acquire pertinent information and give updates on authorizations.
  • Participate in treatment teams to ensure staff have knowledge of coverage and to collect information for communication with agencies.
  • Works with DON to ensure documentation requirements are met.
  • Ensure appeals are completed thoroughly and on a timely basis.
  • Interface with managed care organizations, external reviews, and other payers.
  • Communicate with physicians to schedule peer-to-peer reviews.

What we're looking for
Education: Bachelor's degree required. Master's degree preferred.
Experience: Previous utilization review experience in a psychiatric healthcare facility preferred.
License: Current unencumbered clinical license strongly preferred.
Additional Requirements: CPR certification and Crisis Prevention Training (CPI) preferred. 

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

Comprehensive Benefits: Multiple levels of medical, dental, and vision coverage for full-time and part-time employees
Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave, and paid time off
Financial & Career Growth: Tuition reimbursement and 401(k) retirement package with company match
Employee Well-being: Mental, physical, and financial wellness programs, including Employee Assistance Program and discount programs
Professional Development: Ongoing learning and career advancement opportunities
Additional Perks: Shift differentials and set schedules

EEOC Statement

Lifepoint Behavioral Health is an Equal Opportunity Employer. Lifepoint Behavioral Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.

What LifePoint Health employees say

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Hours and flexibility

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About LifePoint Health

Sourced by ZipRecruiter

Lifepoint Health serves patients, clinicians, communities and partners across the healthcare continuum. Our diversified healthcare delivery network extends from coast to coast, consisting of community hospitals, rehabilitation and behavioral health hospitals, and additional sites of care.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Brentwood, TN, US

Year founded

1999

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