Utilization Review Specialist – Behavioral Health (Remote)

Principles Recovery Center • Davie, FL

9d • Remote

About The Position

Principles Recovery Center (PRC) is hiring a Utilization Review Specialist to manage insurance authorizations for adolescent and adult mental health, substance use, and co-occurring treatment in Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP). This is a remote, full-time role with a Monday–Friday schedule from 9 AM to 5 PM ET.

The specialist supports access to and continuity of care by coordinating with insurance payers, clinical teams, and admissions teams. The position requires at least two years of behavioral health utilization review or authorization experience supporting PHP and IOP programs, and familiarity with medical necessity criteria including ASAM, LOCUS, and CALOCUS.

Requirements

• At least 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.

Nice To Haves

• Kipu EMR experience.
• Multi-payer SCA, appeals, and denial management experience.
• Familiarity with CPT, ICD-10, and DSM-5.
• Bilingual English/Spanish.

Responsibilities

• Verify insurance benefits, eligibility, and coverage requirements.
• Complete prior authorizations, pre-certifications, concurrent reviews, and continued-stay reviews.
• Support medical necessity reviews 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed