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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 ...

CVS Health

Case Manager, Registered Nurse

Raleigh, NC · Remote

$54K - $155K/yr

... remote work from home role anywhere in the US with virtual training. American Health Holding, Inc ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

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All JobsBehavioral Health Utilization Review JobsRemote Behavioral Health Utilization Review JobsRemote Behavioral Health Utilization Review Jobs in Raleigh, NC

Remote Behavioral Health Utilization Review information

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$41

$67

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

As of Jun 16, 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 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 Raleigh, NC? The most popular types of Behavioral Health Utilization Review jobs in Raleigh, NC are:
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Remote Behavioral Health Utilization Review jobs near you

Drug Utilization Review Pharmacist

Pharmacy Careers

Raleigh, NC • On-site, Remote

Other

Medical

Posted 25 days ago

Job description

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications
A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care.
Key Responsibilities

  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health plan requirements.
  • Contribute to quality improvement initiatives and pharmacy program development.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication.


Why This Role?

  • Impact: Shape prescribing decisions that affect thousands of patients.
  • Growth: Build expertise in managed care and population health pharmacy.
  • Flexibility: Many DUR roles offer hybrid or fully remote schedules.
  • Rewards: Competitive salary, benefits, and career advancement opportunities.


About Us
We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations.
Apply Today
Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

Apply