ZipRecruiter

Log In

1

Home Based Behavioral Health Utilization Review Jobs

UHS

Utilization Review Coordinator

Scottsdale, AZ · On-site

Responsibilities Utilization Review Coordinator Full Time Via Linda Behavioral Hospital is a behavioral health provider serving Scottsdale and the greater Phoenix area. We opened in February 2022 and ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

We provide integrated, whole-person care through primary care, specialty care, behavioral health ... evidence-based care for members. This role conducts prior authorizations, facilitates care ...

Nascentia Health

Utilization Review Coordinator

Syracuse, NY · On-site

$19.96 - $24.96/hr

Nascentia Health is leading the way in home care, post acute care and long-term community health. A ... community-based care system for the regions we serve. We want everyone to love what they do, be ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Harahan, LA

... based disorders, compulsive behaviors, and eating disorders, River Oaks has provided quality ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

next page

Showing results 1-20

All JobsHome Based Behavioral Health Utilization Review Jobs

Home Based Behavioral Health Utilization Review information

See salary details

$21

$42

$68

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

As of Jun 14, 2026, the average hourly pay for home based 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 Home Based Behavioral Health Utilization Review?

A Home Based Behavioral Health Utilization Review is the process of evaluating the necessity, appropriateness, and efficiency of behavioral health services provided to patients in their home environments. Professionals in this role review clinical documentation, treatment plans, and service utilization to ensure compliance with insurance policies and regulatory standards. Their goal is to help ensure that patients receive the right care at the right time, while also managing healthcare costs and preventing unnecessary services. This position often involves collaboration with healthcare providers, insurance companies, and patients’ families.

What are some common challenges faced in a home-based behavioral health utilization review role, and how can they be managed?

One common challenge in a home-based behavioral health utilization review role is maintaining effective communication with providers and care teams remotely. Since much of the work is done virtually, it requires strong organizational skills and proficiency with digital tools to ensure timely, accurate reviews and documentation. Additionally, staying updated with constantly changing insurance policies and clinical guidelines can be demanding. Regular training, leveraging collaborative platforms, and setting up structured routines can help professionals manage these challenges successfully.

What is the difference between Home Based Behavioral Health Utilization Review vs Outpatient Behavioral Health Clinician?

AspectHome Based Behavioral Health Utilization ReviewOutpatient Behavioral Health Clinician
CredentialsLicenses in mental health or social work, certifications in utilization reviewLicenses in mental health or social work, clinical certifications
Work EnvironmentRemote, reviewing cases from home or officeClinic or outpatient setting, direct patient interaction
Employer & Industry UsageHealth plans, managed care organizationsHospitals, outpatient clinics, private practices
Primary FocusReviewing treatment necessity, authorization, and complianceProviding direct therapy and clinical assessments

Home Based Behavioral Health Utilization Review professionals focus on evaluating treatment plans and authorizations remotely, ensuring appropriate care. Outpatient Behavioral Health Clinicians provide direct patient care in clinical settings. Both roles require mental health licensure but differ mainly in job functions and work environment.

What are the key skills and qualifications needed to thrive as a Home Based Behavioral Health Utilization Review Specialist, and why are they important?

To thrive as a Home Based Behavioral Health Utilization Review Specialist, you need a background in behavioral health or social work, typically with relevant licensure (e.g., LCSW, LMHC, RN) and experience in case management or utilization review. Familiarity with utilization management software, electronic health record (EHR) systems, and knowledge of insurance guidelines and regulatory standards are essential. Strong analytical thinking, attention to detail, and clear communication skills help professionals effectively assess cases and advocate for appropriate care. These competencies ensure accurate service authorization, compliance with regulations, and improved patient outcomes in a remote setting.
What cities are hiring for Home Based Behavioral Health Utilization Review jobs? Cities with the most Home Based Behavioral Health Utilization Review job openings:
What are the most commonly searched types of Behavioral Health Utilization Review jobs? The most popular types of Behavioral Health Utilization Review jobs are:
What states have the most Home Based Behavioral Health Utilization Review jobs? States with the most job openings for Home Based Behavioral Health Utilization Review jobs include:
Home Based Behavioral Health Utilization Review jobs near you
Nurse Practitioner, Behavioral Health UM (PMHNP)

Nurse Practitioner, Behavioral Health UM (PMHNP)

Molina Healthcare

Long Beach, CA • On-site

$111K - $152K/yr

Full-time

Posted 11 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

147th of 261 rated insurance

Job description

Job Description

Job Summary

Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of clinical decision-making across markets. Participates in a team-based, physician-led model that aligns with national clinical oversight standards and enterprise behavioral health initiatives. Contributes to overarching strategy to provide quality and cost-effective member care.

 
Job Duties
  • Performs Behavioral Health utilization management reviews for inpatient, outpatient, and intermediate-level services using nationally recognized criteria (e.g., MCG, InterQual, ASAM).
  • Reviews medical documentation to determine the medical necessity, level of care, and continued stay appropriateness for behavioral health services.
  • Collaborates with Behavioral Health Medical Directors on complex or borderline cases, ensuring consistent application of criteria and alignment with regulatory standards.
  • Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate.
  • Maintains compliance with federal, state, and accreditation requirements (e.g., NCQA, URAC, CMS).
  • Participates in UM quality audits, internal case reviews, and peer-to-peer education.
  • Supports process improvement initiatives and contributes to the development of clinical review guidelines and training materials.
  • Works under the medical direction and supervision of a licensed physician, consistent with state law and corporate policy.
  • Obtains and maintains multi-state licensure to support national coverage needs.
  • Participates in enterprise Behavioral Health workgroups, SAIs, and other cross-functional initiatives as assigned.
  • Provides input to leadership regarding UM workflow optimization and emerging utilization trends.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • Master's degree in Psychiatric-Mental Health Nursing from an accredited program.
  • Completion of a Psychiatric-Mental Health Nurse Practitioner program at the master's level with current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC).
  • Minimum 3 years of experience as a Nurse Practitioner, ideally in managed care, behavioral health, or utilization management.
  • Demonstrated experience in the application of medical necessity criteria and regulatory guidelines.
  • Active, unrestricted state license in SC to practice as a PMHNP, with the ability to obtain cross-state licensure as required.
PREFERRED QUALIFICATIONS:
  • Prior experience in a managed care organization or payer-based utilization management setting.
  • Familiarity with Medicaid, Marketplace, and Medicare behavioral health regulations.
  • Strong working knowledge of clinical criteria (e.g., ASAM, MCG, InterQual).
  • Computer proficiency and experience with electronic medical record or UM systems.
  •  
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.  
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Molina Healthcare logo

About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

FacebookTwitter

View All Molina Healthcare Jobs

Apply