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Remote Behavioral Health Utilization Review Jobs

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

Meadows Behavioral Healthcare offer a range of specialized programs including residential ... As the Utilization Review Coordinator, you will develop and implement systems for authorizations ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

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

As of Jun 14, 2026, the average hourly pay for remote 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 Remote Behavioral Health Utilization Review job?

A Remote Behavioral Health Utilization Review job involves evaluating behavioral health treatment plans and services to ensure they meet insurance guidelines, medical necessity, and regulatory requirements. Professionals in this role review clinical documentation, assess patient needs, and collaborate with healthcare providers to determine appropriate levels of care. They work remotely, often for insurance companies or healthcare organizations, to authorize or deny coverage based on established criteria. Strong clinical knowledge, attention to detail, and communication skills are essential for success in this role.

What are the key skills and qualifications needed to thrive in the Remote Behavioral Health Utilization Review position, and why are they important?

To excel in Remote Behavioral Health Utilization Review, candidates generally need a clinical background such as a nursing or social work license, strong analytical skills, and experience with behavioral health diagnoses and treatment planning. Familiarity with utilization management software, electronic health records (EHRs), and insurance coding systems is often required, along with certifications like CCM (Certified Case Manager) or URAC accreditation being valued. Excellent communication, critical thinking, and organizational skills help professionals handle complex cases and collaborate effectively in a virtual team environment. These competencies ensure accurate review of mental health services, compliance with payer requirements, and optimal patient outcomes.

What are the typical daily responsibilities for someone working in Remote Behavioral Health Utilization Review?

In a Remote Behavioral Health Utilization Review role, your daily tasks often include reviewing clinical documentation, assessing medical necessity for behavioral health services, and making authorization or denial recommendations according to established guidelines. You’ll frequently interact with providers, case managers, and insurance representatives to gather information and clarify care requests. Additionally, your day may involve documenting decisions, participating in case review meetings, and staying updated on evolving policies. Working remotely, you'll communicate primarily via secure electronic systems, phone, and video conferencing. This structure typically offers flexibility but also requires strong self-motivation and organization.

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Remote Behavioral Health Utilization Review jobs near you
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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