Remote Behavioral Health Utilization & Authorization Specialist

Adolescent Wellness Academy; United States; Remote; USD 68,770,000 - 74,677,000; Full time

Job summary

Adolescent Wellness Academy (AWA) is hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment. The role requires 2+ years of PHP/IOP UR/authorization experience and knowledge of ASAM, LOCUS, and CALOCUS.

You will verify benefits, complete authorizations, and coordinate with payers while supporting continuity of care with clinical and admissions teams.

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.

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.

Skills

UR Experience

ASAM LOCUS CALOCUS

EMR/EHR

Payer liaison

Remote Work

Tools

Kipu EMR

Authorization software

Job description

Adolescent Wellness Academy (AWA) is hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment. The role requires 2+ years of PHP/IOP UR/authorization experience and knowledge of ASAM, LOCUS, and CALOCUS.

You will verify benefits, complete authorizations, and coordinate with payers while supporting continuity of care with clinical and admissions teams.