Remote Behavioral Health Utilization Review Specialist

Principles Recovery Center; Florida; Remote; USD 50,000 - 54,000; Full time

Job summary

Principles Recovery Center in Florida is seeking a remote Utilization Review Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment in a PHP/IOP setting.

You will verify benefits, complete prior authorizations and continued-stay reviews, coordinate denials and SCAs with payers, and support continuity of care with EMR/EHR documentation, ASAM LOCUS CALOCUS criteria, and strong payer advocacy.

Qualifications

• 2+ years of PHP/IOP utilization review or insurance authorization in a behavioral health facility.
• Knowledge of ASAM, LOCUS, CALOCUS and medical necessity standards.
• Experience communicating with insurance payers and managed care organizations.
• Proficiency with EMR/EHR platforms and authorization software.
• Eligible for DCF/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, CALOCUS criteria.
• Obtain 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

Behavioral health UR

Payer advocacy

Remote work ability

Tools

EMR/EHR

Kipu EMR

Authorization software

Job description

Principles Recovery Center in Florida is seeking a remote Utilization Review Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment in a PHP/IOP setting.

You will verify benefits, complete prior authorizations and continued-stay reviews, coordinate denials and SCAs with payers, and support continuity of care with EMR/EHR documentation, ASAM LOCUS CALOCUS criteria, and strong payer advocacy.