Utilization Review Specialist – Behavioral Health (Remote)
About The Position
Principles Recovery Center (PRC) is hiring a remote 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). The role is full-time, Monday through Friday, 9 AM–5 PM ET, with a pay rate of $24–$26 per hour. The specialist supports access to and continuity of care by coordinating with insurance payers, clinical teams, and admissions teams. The work includes verifying coverage, obtaining and maintaining authorizations, supporting medical-necessity reviews, managing appeals, and maintaining accurate authorization records. The organization provides behavioral health PHP/IOP treatment across South Florida.
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 determinations 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
