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Remote Behavioral Health Utilization Review Jobs in Raleigh, NC

April Health

Behavioral Health Care Manager

Durham, NC · On-site +1

$53K - $58K/yr

Are you passionate about increasing access to behavioral health services? Have you worked in ... Remote work * Fantastic total rewards package, including health, vision, dental, etc. * Working ...

Centene

Psychologist Reviewer

Durham, NC · On-site +1

$87K - $157K/yr

... based behavioral health care. Why Join Us? * 100% remote flexibility * Meaningful work impacting ... Interact with network practitioners to provide education on best practice models and utilization ...

Senture

Medical Director

Raleigh, NC · Remote

... health plan, or utilization management operation The Medical Director works collaboratively with organizational leadership, credentialing staff, peer reviewers, and regulatory stakeholders to ensure ...

Red Oak Recovery Center

Clinical Director

Durham, NC · Remote

$81K - $111K/yr

... behavioral health services. This role involves supervising clinical staff, managing patient care ... Participate in utilization review meetings, representing patient needs in both clinical and ...

Kind Behavioral Health

Senior Accountant

Raleigh, NC · On-site +1

$71K - $90K/yr

Kind Behavioral Health is a leading provider of Applied Behavior Analysis services, dedicated to ... Review key business process designs to improve expediency, efficiency, and quality while ensuring ...

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Remote Behavioral Health Utilization Review information

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

As of Aug 26, 2026, the average hourly pay for remote behavioral health utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 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 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 most commonly searched types of Behavioral Health Utilization Review jobs in Raleigh, NC?

The most popular types of Behavioral Health Utilization Review jobs in Raleigh, NC are:

What are popular job titles related to Remote Behavioral Health Utilization Review jobs in Raleigh, NC?

For Remote Behavioral Health Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Remote Behavioral Health Utilization Review jobs in Raleigh, NC look for?

The top searched job categories for Remote Behavioral Health Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Remote Behavioral Health Utilization Review jobs?

Cities near Raleigh, NC 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 Raleigh, NC as of August 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 100% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 20 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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