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Remote Behavioral Health Utilization Review Jobs in Nevada

Open Mind Health

Client Liaison

Reno, NV · Remote

$17 - $20/hr

Remote | Reports to Chief Clinical Officer $17-$20/hour About Open Mind Health Open Mind Health is a nationwide virtual behavioral health organization providing psychotherapy, psychiatry, and ...

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

As of Aug 6, 2026, the average hourly pay for remote behavioral health utilization review in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 per hour, depending on experience, location, and employer.

What is a remote behavioral health utilization review?

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 remote behavioral health utilization review, 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.

What are the most commonly searched types of Behavioral Health Utilization Review jobs in Nevada? The most popular types of Behavioral Health Utilization Review jobs in Nevada are:
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What job categories do people searching Remote Behavioral Health Utilization Review jobs in Nevada look for? The top searched job categories for Remote Behavioral Health Utilization Review jobs in Nevada are:
What cities in Nevada are hiring for Remote Behavioral Health Utilization Review jobs? Cities in Nevada with the most Remote Behavioral Health Utilization Review job openings:
Remote Behavioral Health Utilization Review jobs near you
Infographic showing various Remote Behavioral Health Utilization Review job openings in Nevada as of August 2026, with employment types broken down into 83% Full Time, 6% Part Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $89,556 per year, or $43.1 per hour.

Medical Director, Utilization Management (Commercial & MA)

HJ Staffing

Henderson, NV • Remote

Full-time

Medical

Posted 15 days ago

Job description

We are seeking a Medical Director of Utilization Management to lead and support the clinical integrity of our utilization management (UM) functions, with a primary focus on inpatient and post-acute care reviews.

In this role, you will ensure timely, consistent, and appropriate care determinations for Commercial and Medicare Advantage members. By leveraging evidence-based practices, CMS regulations, and health plan benefit structures, you will evaluate the medical necessity of care, participate in peer-to-peer consultations, and collaborate with multidisciplinary teams to drive optimal clinical outcomes, regulatory compliance, and cost efficiency.

Duration: August 10, 2026 - February 10, 2027

Location: Henderson, NV (100% Fully Remote Opportunity)

Reporting To: Chief Medical Officer

Start Date: Immediate Need

Key Responsibilities
  • Utilization Review & Medical Necessity: Conduct timely medical necessity determinations for inpatient admissions, continued stays, and post-acute care settings (SNF, IRF, LTACH, Home Health) for Commercial and Medicare Advantage populations.
  • Evidence-Based Evaluation: Apply nationally recognized guidelines (MCG, InterQual), CMS coverage criteria, and health plan policies to ensure appropriate level-of-care determinations.
  • Complex Case Escalation: Serve as the lead physician reviewer for complex, high-risk, or potentially adverse UM cases requiring clinical judgment.
  • Peer-to-Peer Engagement: Conduct peer-to-peer discussions with attending and treating physicians to clarify documentation, discuss options, and align on appropriate care plans.
  • Cross-Functional Collaboration: Partner with Care Management and UM teams to identify utilization trends, reduce avoidable readmissions/extended stays, and streamline care transitions.
  • Policy & Quality Support: Offer clinical expertise to support quality improvement initiatives, regulatory audit preparedness (CMS/NCQA), policy development, and UM committee activities.
  • Documentation & Compliance: Maintain precise, compliant, and timely documentation of all reviews and rationales in accordance with federal, state, and organizational guidelines.
Must-Have Qualifications
  • Education & Licensure: Active M.D. or D.O. degree with an active, unrestricted medical license in good standing (in state of residence).
  • Board Certification: Current Board Certification in an appropriate medical specialty.
  • Clinical & Leadership Experience: Minimum of 5 years of clinical practice, including at least 3 years of direct experience in utilization management, physician review, or medical leadership within a managed care or health plan setting.
  • Population Expertise: Demonstrated physician-level experience supporting Commercial and/or Medicare Advantage lines of business.
What Will Make You Successful
  • Criteria Proficiency: Advanced expertise with MCG guidelines and strong working knowledge of InterQual and CMS criteria.
  • Regulatory Knowledge: Deep understanding of Medicare Advantage regulations, Commercial health plan benefit structures, and state/federal UM mandates.
  • Technical Skills: Experience navigating medical management platforms, enterprise applications, and Microsoft Office products.
  • Communication & Negotiation: Exceptional written and oral communication skills, with a proven ability to handle delicate peer-to-peer discussions and articulate complex clinical rationales clearly.
  • Analytical Mindset: Strong problem-solving abilities, attention to detail, and a data-driven approach to identifying utilization trends and quality gaps.
Preferred Qualifications
  • Master's degree in Public Health, Business Administration, or Health Administration (MPH, MBA, or MHA).
  • Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
Why Apply?

This is a 100% remote, high-impact contract opportunity starting immediately, offering you the flexibility of working from home while managing key clinical determinations for a dynamic health plan environment.

Employment Type: FULL_TIME

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