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Remote Behavioral Health Utilization Review Jobs

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...

Dane Street, LLC

Utilization Review Physician

Overview We are seeking a high-performing Physician Reviewer to join our Group Health division. The ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... Health Care Insurance Company. * Knowledge of medical terminology and procedures. * Verbal and ...

Franciscan Health

Utilization Review Coordinator

Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care ... Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial ...

Inficare Technologies

Behavioral Health Clinician

$63K - $87K/yr

Job Title - Behavioral Health Clinician Job Location - Remote but Must Reside in the state of ... Experience in Utilization Review (UR) and Utilization Management (UM) within behavioral health or ...

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

As of Jul 13, 2026, the average hourly pay for remote behavioral health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.

More about Remote Behavioral Health Utilization Review jobs
What cities are hiring for Remote Behavioral Health Utilization Review jobs? Cities with the most Remote Behavioral Health Utilization Review job openings:
What are the most commonly searched types of Behavioral Health Utilization Review jobs? The most popular types of Behavioral Health Utilization Review jobs are:
What states have the most Remote Behavioral Health Utilization Review jobs? States with the most job openings for Remote Behavioral Health Utilization Review jobs include:
What job categories do people searching Remote Behavioral Health Utilization Review jobs look for? The top searched job categories for Remote Behavioral Health Utilization Review jobs are:
Remote Behavioral Health Utilization Review jobs near you
Infographic showing various Remote Behavioral Health Utilization Review job openings in the United States as of July 2026, with employment types broken down into 68% Full Time, 19% Part Time, and 13% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Nurse Practitioner, Behavioral Health UM (PMHNP)

Nurse Practitioner, Behavioral Health UM (PMHNP)

Molina Healthcare

Long Beach, CA • On-site, Remote

$84K - $172K/yr

Full-time

Re-posted 12 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

134th of 281 rated insurance

Job description


Job Description
Job Summary
Performs behavioral health utilization reviews, applying evidence-based criteria, and collaborating with physicians to ensure clinically appropriate, cost-effective, and regulatory-compliant care determinations. Assists in evaluating medical necessity, ensuring timeliness, and supporting the consistency of clinical decision-making across markets. Participates in a team-based, physician-led model that aligns with national clinical oversight standards and enterprise behavioral health initiatives. Contributes to overarching strategy to provide quality and cost-effective member care.
Job Duties
  • Performs Behavioral Health utilization management reviews for inpatient, outpatient, and intermediate-level services using nationally recognized criteria (e.g., MCG, InterQual, ASAM).
  • Reviews medical documentation to determine the medical necessity, level of care, and continued stay appropriateness for behavioral health services.
  • Collaborates with Behavioral Health Medical Directors on complex or borderline cases, ensuring consistent application of criteria and alignment with regulatory standards.
  • Identifies quality-of-care, safety, and compliance concerns and escalate to the Medical Director as appropriate.
  • Maintains compliance with federal, state, and accreditation requirements (e.g., NCQA, URAC, CMS).
  • Participates in UM quality audits, internal case reviews, and peer-to-peer education.
  • Supports process improvement initiatives and contributes to the development of clinical review guidelines and training materials.
  • Works under the medical direction and supervision of a licensed physician, consistent with state law and corporate policy.
  • Obtains and maintains multi-state licensure to support national coverage needs.
  • Participates in enterprise Behavioral Health workgroups, SAIs, and other cross-functional initiatives as assigned.
  • Provides input to leadership regarding UM workflow optimization and emerging utilization trends.

Job Qualifications
REQUIRED QUALIFICATIONS:
  • Master's degree in Psychiatric-Mental Health Nursing from an accredited program.
  • Completion of a Psychiatric-Mental Health Nurse Practitioner program at the master's level with current national certification (PMHNP-BC) from the American Nurses Credentialing Center (ANCC).
  • Minimum 3 years of experience as a Nurse Practitioner, ideally in managed care, behavioral health, or utilization management.
  • Demonstrated experience in the application of medical necessity criteria and regulatory guidelines.
  • Active, unrestricted state license in SC to practice as a PMHNP, with the ability to obtain cross-state licensure as required.

PREFERRED QUALIFICATIONS:
  • Prior experience in a managed care organization or payer-based utilization management setting.
  • Familiarity with Medicaid, Marketplace, and Medicare behavioral health regulations.
  • Strong working knowledge of clinical criteria (e.g., ASAM, MCG, InterQual).
  • Computer proficiency and experience with electronic medical record or UM systems.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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