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Remote Behavioral Health Utilization Review Jobs in Wisconsin

WPS

Medical Review Nurse Analyst

Madison, WI · On-site +1

$68K - $70K/yr

Experience with medical record review or utilization review. Remote Work Requirements * Wired ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

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Remote Behavioral Health Utilization Review information

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.

What are the most commonly searched types of Behavioral Health Utilization Review jobs in Wisconsin? The most popular types of Behavioral Health Utilization Review jobs in Wisconsin are:
What are popular job titles related to Remote Behavioral Health Utilization Review jobs in Wisconsin? For Remote Behavioral Health Utilization Review jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Behavioral Health Utilization Review jobs in Wisconsin look for? The top searched job categories for Remote Behavioral Health Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Behavioral Health Utilization Review jobs? Cities in Wisconsin 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 Wisconsin as of July 2026, with employment types broken down into 2% As Needed, 75% Full Time, 18% Part Time, and 5% Contract. Highlights an 95% Physical, 2% Hybrid, and 3% Remote job distribution.

Utilization Review Specialist-Remote

Wellbrook Recovery

Brookfield, WI • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

Utilization Review Specialist – Behavioral Health Facility

We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.

Responsibilities:

  • Conduct utilization reviews and obtain prior authorizations from insurance companies

  • Monitor continued stay and discharge criteria for clients

  • Communicate effectively with clinical and administrative teams

  • Maintain accurate and up-to-date documentation

  • Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.

Qualifications:

  • Background or experience in social work, counseling, or behavioral health is preferred

  • Experience in utilization review or case management for behavioral health is preferred

  • Strong communication and organization skills

  • Ability to work efficiently in a fast-paced environment

  • Confident, proactive, and dedicated work ethic

Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues

Benefits:

  • 401(k)

  • Dental insurance

  • Flexible schedule

  • Health insurance

  • Life insurance

  • Paid time off

  • Vision insurance