Utilization Review Specialist – Behavioral Health

Utilization Review Specialist – Behavioral Health (Remote)

PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$26/hour

About the Role

Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult mental health, substance use, and co-occurring treatment .

Required: 2+ years of behavioral health UR/authorization experience supporting Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).

Responsibilities

- Verify insurance benefits, eligibility, and coverage requirements.

- Complete prior authorizations, pre-certifications, concurrent reviews, and continued-stay reviews .

- Support medical necessity using ASAM, LOCUS, and CALOCUS criteria.

- Obtain Single Case Agreements (SCAs) with out-of-network payers.

- Submit denial appeals and coordinate peer-to-peer reviews.

- Track authorized units, coverage dates, and payer deadlines.

- Collaborate with clinical and admissions teams to support continuity of care.

- Maintain accurate authorization records in the EMR/EHR .

Required Qualifications

-
2+ years of PHP/IOP utilization review, utilization management, or insurance authorization experience in a behavioral health facility.

- Knowledge of ASAM, LOCUS, CALOCUS, and medical necessity standards .

- Experience communicating with insurance payers and managed care organizations.

- Strong case tracking, documentation, organization, and payer advocacy skills.

- Proficiency with EMR/EHR platforms and authorization software.

- Ability to work independently in a remote setting.

- Eligibility for DCF and AHCA Level 2 background screening.

Preferred Qualifications

-
Kipu EMR experience.

- Multi-payer SCA, appeals, and denial management experience.

- Familiarity with CPT, ICD-10, and DSM-5 .

- Bilingual English/Spanish.

Our Mission

AWA and PRC provide behavioral health PHP/IOP treatment across South Florida. Your work helps clients and families access care and stay connected to treatment.

Learn More: Principles Recovery Center

Salary: $24 – $28 / hour
Originally posted on Himalayas