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Senior Behavioral Health Utilization Review Jobs

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing an intentionally different approach to mental health and well-being. We are a combination of bricks ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... Associate's or Bachelor's degree in Healthcare Administration, Medical Records, Behavioral Health ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... Associate's or Bachelor's degree in Healthcare Administration, Medical Records, Behavioral Health ...

UHS

Utilization Review Coordinator

Champaign, IL · On-site

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health ... and senior adults can find hope and healing from emotional psychiatric and addictive diseases.

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Senior Behavioral Health Utilization Review information

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$31K

$79.8K

$117K

How much do senior behavioral health utilization review jobs pay per year?

As of Jun 14, 2026, the average yearly pay for senior behavioral health utilization review in the United States is $79,771.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $116,500.00 per year, depending on experience, location, and employer.

What is the difference between Senior Behavioral Health Utilization Review vs Behavioral Health Case Manager?

AspectSenior Behavioral Health Utilization ReviewBehavioral Health Case Manager
CredentialsLicenses (e.g., RN, LCSW), certifications in utilization reviewLicenses (e.g., LCSW, LPC), case management certifications
Work EnvironmentHealthcare facilities, insurance companies, managed care organizationsHospitals, community clinics, outpatient centers
Primary FocusReviewing medical necessity, authorizing services, ensuring appropriate utilizationCoordinating care, supporting patient needs, connecting clients with resources

While both roles involve behavioral health, the Senior Behavioral Health Utilization Review focuses on evaluating and authorizing services based on medical necessity, often within insurance or managed care settings. In contrast, Behavioral Health Case Managers actively coordinate patient care and support recovery efforts. Understanding these differences helps clarify career paths and employer expectations in behavioral health services.

More about Senior Behavioral Health Utilization Review jobs
What cities are hiring for Senior Behavioral Health Utilization Review jobs? Cities with the most Senior 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 Senior Behavioral Health Utilization Review jobs? States with the most job openings for Senior Behavioral Health Utilization Review jobs include:
What job categories do people searching Senior Behavioral Health Utilization Review jobs look for? The top searched job categories for Senior Behavioral Health Utilization Review jobs are:
Senior Behavioral Health Utilization Review jobs near you
Infographic showing various Senior Behavioral Health Utilization Review job openings in the United States as of June 2026, with employment types broken down into 85% Full Time, and 15% Part Time. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $79,771 per year, or $38.4 per hour.
Utilization Review Specialist

Utilization Review Specialist

Lighthouse Behavioral Health Solutions

Columbus, OH

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

Lighthouse Behavioral Health Solutions (LBHS) offers a full continuum of care, including outpatient, intensive outpatient, partial hospitalization, residential treatment, psychiatric services, and medication‑assisted treatment. We take pride in creating a welcoming, compassionate environment where individuals feel supported. Our team believes in every client's ability to achieve recovery and rebuild meaningful, engaged lives in their communities.

Position: Utilization Review Specialist

Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical criteria for admission, continued stay, and discharge. This role supports compliance with payer requirements, maintains proper documentation, and collaborates with clinical and administrative teams to maximize reimbursement while ensuring high-quality, medically necessary care.

Reports to: VP of Revenue Cycle Management

Duties and Responsibilities:

Duties include, but are not limited to:

  • Conduct initial and concurrent reviews to determine medical necessity using established criteria
  • Submit authorization requests and clinical documentation to insurance providers in a timely manner
  • Monitor authorizations and ensure services rendered align with approved levels of care
  • Track and manage authorization expirations and initiate reauthorization requests as needed
  • Review clinical records for completeness, accuracy, and compliance with payer and regulatory standards
  • Ensure treatment plans, progress notes, and discharge summaries support medical necessity
  • Provide feedback to clinical staff to improve documentation quality
  • Maintain adherence to HIPAA and confidentiality regulations
  • Serve as the primary liaison between the organization and insurance companies for utilization review matters
  • Participate in peer-to-peer reviews when required
  • Address denials by gathering supporting documentation and submitting appeals
  • Stay current with payer guidelines and regulatory changes affecting SUD services
  • Collaborate with clinical, admissions, billing, and case management teams to ensure continuity of care and proper utilization of services
  • Participate in multidisciplinary team meetings to discuss patient progress and level-of-care needs
  • Communicate authorization status and payer requirements to relevant staff
  • Maintain accurate records of authorizations, denials, and appeals
  • Track utilization metrics and identify trends to improve efficiency and reimbursement
  • Participate in audits and quality assurance initiatives
  • Perform other duties as assigned

Required Experience/Abilities:

  • Bachelor's degree in behavioral health, nursing, social work, or a related field required.
  • Knowledge of ASAM Criteria required
  • Minimum of 1 year of experience in utilization review, case management, or clinical services within behavioral health or SUD treatment
  • Experience working with commercial insurance, Medicaid, and/or Medicare preferred
  • Familiarity with electronic health record (EHR) systems
  • Must pass BCI check, all Corporate Compliance checks, and employment drug screen

Desired Experience/Abilities:

  • Master's degree or clinical licensure (e.g., LSW, LPC, LCSW, RN) preferred.3 years in a supervisory or management role within a behavioral health setting
  • Working knowledge of CPT and ICD-10 coding systems, with relevant certification (e.g., CPC, CCS-P) or equivalent experience
  • Understanding of medical necessity criteria, including experience with InterQual and/or Milliman (MCG) guidelines

Location: Columbus, OH

Our benefits package includes paid time off (PTO and sick time), paid holidays, medical/dental/vision, 401(k), life insurance, paid continuing education with supervision, parental leave, and eligibility for loan forgiveness programs.

LBHS is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, age, color, religion, sex, national origin, sexual orientation, disability status, genetics, gender identity and/or expression, protected veteran status, or any other characteristic protected by federal, state, or local law.

LBHS adheres to Title VII of the Civil Rights Act as amended, Ohio Civil Rights Act, and all applicable rules and regulations. LBHS is an equal opportunity employer.