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