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Remote Behavioral Health Utilization Review Jobs in Ohio

CareSource

Behavioral Health Medical Director

Dayton, OH · On-site +1

$195K - $341K/yr

The Market Behavioral Health Medical Director is responsible for the overall safety of patients ... Review utilization data to identify variances in patterns and provide feedback and education to ...

CareSource

Behavioral Health Medical Director

Dayton, OH · On-site +1

$195K - $341K/yr

Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of ... the review of utilization data to identify variances in patterns, and provide feedback and ...

Miamioh

$44K - $61K/yr

Job Title Behavioral Health Post Doctoral Fellow Department Student Counseling Worker Type ... Remote work is not a right, it is a work arrangement that can be modified or revoked by Miami ...

Miamioh

Behavioral Health Post Doctoral Fellow

Oxford, OH · On-site +1

$46K - $62K/yr

Job Title Behavioral Health Post Doctoral Fellow Department Student Counseling Worker Type ... Remote work is not a right, it is a work arrangement that can be modified or revoked by Miami ...

NewVista Behavioral Health

$65K - $70K/yr

... Solero Behavioral Transitions of Columbus is currently recruiting a licensed clinician for a ... A mental health residential facility is a place where people receive intensive, specialized care ...

Team Recovery Ohio LLC

Virtual Therapist

Toledo, OH · On-site +1

$401K/yr

Stay informed regarding current evidence-based practices, treatment modalities, behavioral health ... reviews, utilization management processes, and coordination of care with insurance providers and ...

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

As of Aug 8, 2026, the average hourly pay for remote behavioral health utilization review in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 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 Ohio? The most popular types of Behavioral Health Utilization Review jobs in Ohio are:
What are popular job titles related to Remote Behavioral Health Utilization Review jobs in Ohio? For Remote Behavioral Health Utilization Review jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Remote Behavioral Health Utilization Review jobs in Ohio look for? The top searched job categories for Remote Behavioral Health Utilization Review jobs in Ohio are:
What cities in Ohio are hiring for Remote Behavioral Health Utilization Review jobs? Cities in Ohio 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 Ohio as of August 2026, with employment types broken down into 84% Full Time, 11% Part Time, and 5% Contract. Highlights an 100% Remote job distribution, with an average salary of $83,610 per year, or $40.2 per hour.

Behavioral Health Medical Director

CareSource

Dayton, OH • On-site, Remote

$195K - $341K/yr

Full-time

Re-posted 23 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

200th of 303 rated insurance

Job description

Job Summary:
The Market Behavioral Health Medical Director is responsible for the overall safety of patients with a Behavioral Health diagnosis, with a special focus on safe prescribing.
Essential Functions:
  • Assume responsibility for the overall safety of patients with a behavioral health (BH) diagnosis, focusing on safe prescribing practices
  • Serve as the psychiatric lead in developing and implementing evidenced based clinical BH policies and practices for the state
  • Conduct regulatory and accreditation reviews to ensure compliance with applicable standards
  • Oversee BH coverage determination for utilization management, ensuring members receive appropriate and medically necessary care in the most cost-effective setting
  • Lead quality improvement initiatives, case management activities and member safety protocols, including incident management
  • Review utilization data to identify variances in patterns and provide feedback and education to Managed Care Plan (MCP) staff and providers as needed
  • Represent CareSource as the primary psychiatric liaison to members, providers and state agencies
  • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Contribute to the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
  • Collaborate with market and product leaders to define market strategy and enhance the quality and affordability of BH services
  • Participate in community collaborative initiatives to improve BH services
  • Evaluate and investigate cases suspected of fraud, abuse, and quality of care concerns
  • Provide cross-coverage for other Medical Directors and/or markets, as needed
  • Support staff through training, clinical consultation, and clinical case review for members, including Medical Advisement meetings
  • Advocate for behavioral health in collaboration with the Market's government affairs and regulatory leads to advance CareSource's mission and meet specific advocacy goals
  • Strengthen and develop relationships with specialty (CBHC) and IMD (standalone hospital) providers as needed in the Market
  • Engage in Market professional society activities to enhance CareSource's objectives
  • Consult with Market and Enterprise leadership to improve quality for members through collaborative execution of behavioral health quality improvement activities, including HEDIS and value-based reimbursement contracting
  • Act as liaison with state agencies and organizations on BH initiatives, residing in the state market if required
  • Perform any other job related duties as requested.

Education and Experience:
  • Medical Doctor (MD) required or
  • Doctor of Osteopathic Medicine (DO) required
  • Successful completion of a residency training program in psychiatry required
  • Five (5) years of clinical practice experience required
  • Experience in safe prescribing required
  • Managed care medical review/medical director experience preferred
  • Residence and clinical practice in assigned market may be required preferred
Competencies, Knowledge and Skills:
  • Basic Microsoft Word skills
  • Excellent communication skills, both written and oral
  • Ability to work well independently and within a team environment
  • Ability to create strong relationships with Providers and Members
  • Previous Institute for Healthcare Improvement (IHI) or equivalent training participation is preferred
  • High ethical standards
  • Attention to detail
  • Critical listening and systematic thinking skills
  • Ability to maintain confidentiality and act in the company's best interest
  • Ability to act with diplomacy and sensitivity to cultural diversity
  • Decision making/problem solving skills
  • Conflict resolution skills
  • Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
  • Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
  • Leadership experience and skills
Licensure and Certification:
  • Current, unrestricted license to practice medicine in state of practice as necessary to meet regulatory requirements required
  • Board Certification in Psychiatry required
  • Re-certification, as required by specialty board, must be maintained
  • MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Flexible hours, including possible evenings and/or weekends as needed.
  • Ability to travel as required by the needs of the department.

Compensation Range:
$195,200.00 - $341,600.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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Brand=CareSource

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