ZipRecruiter

Log In

2

Full Time 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 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 ...

KMRG LLC

Behavioral Health Case Manager

Raleigh, NC · On-site

$95K - $115K/yr

Raleigh, NC Schedule: Full-time, primarily onsite Monday-Friday, with occasional statewide travel ... Applications will be reviewed as they are received. Apply today! RESPONSIBILITIES Clinical Case ...

Lifepoint Health

Behavioral Health Technician

Louisburg, NC · On-site

$14.50 - $18/hr

Adult Behavioral Health Tech I Job Type: Full Time | Nights Your experience matters At Maria Parham Hospital, we are driven by a profound commitment to prioritize your well-being so you can provide ...

next page

Showing results 1-20

All JobsBehavioral Health Utilization Review JobsFull Time Behavioral Health Utilization Review JobsFull Time Behavioral Health Utilization Review Jobs in Raleigh, NC

Full Time Behavioral Health Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Aug 6, 2026, the average hourly pay for full time 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 are some common challenges faced by behavioral health utilization review professionals, and how can they be addressed?

Behavioral Health Utilization Review professionals often encounter challenges such as managing high caseloads, staying current with changing insurance policies, and effectively communicating clinical needs to payers. Balancing administrative requirements with patient advocacy can be demanding, especially when there is pressure to ensure timely reviews and approvals. To address these challenges, strong organizational skills, ongoing professional development, and collaboration with interdisciplinary teams are essential. Utilizing up-to-date technology and participating in regular training can also help streamline processes and improve outcomes.

What is a full time behavioral health utilization review?

A Full Time Behavioral Health Utilization Review professional evaluates mental health and substance use treatment plans to ensure they meet clinical guidelines and are medically necessary. They review patient records, coordinate with healthcare providers, and make recommendations regarding the approval or denial of services. These professionals help manage healthcare costs while ensuring patients receive appropriate care. Their expertise is essential in maintaining compliance with insurance and regulatory requirements, and they often serve as a bridge between treatment providers and insurance companies.

What are the key skills and qualifications needed to thrive as a full time behavioral health utilization review specialist, and why are they important?

To thrive as a Full Time Behavioral Health Utilization Review Specialist, you need clinical expertise in behavioral health, knowledge of insurance guidelines, and typically a degree in nursing, social work, or a related field with relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and standardized assessment tools is essential. Strong analytical skills, attention to detail, and effective communication are vital soft skills for collaborating with providers and advocating for patients. These competencies ensure appropriate care authorization, regulatory compliance, and quality outcomes for both patients and healthcare organizations.
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:
What are popular job titles related to Full Time Behavioral Health Utilization Review jobs in Raleigh, NC? For Full Time Behavioral Health Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Full Time Behavioral Health Utilization Review jobs in Raleigh, NC look for? The top searched job categories for Full Time Behavioral Health Utilization Review jobs in Raleigh, NC are:
Full Time Behavioral Health Utilization Review jobs near you

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 2 hours ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

Powered by JazzHR

nQSfGpNUXN