Remote Behavioral Health Utilization Review Specialist

Principles Recovery Center; United States; Remoto; USD 33.000 - 39.000; Tempo pieno

Descrizione del lavoro

Principles Recovery Center is seeking a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment. This is a remote, full-time role with standard hours 9 AM–5 PM ET, Monday–Friday.

You will verify benefits, complete authorizations, and support medical necessity using ASAM, LOCUS, and CALOCUS, coordinating with clinical teams to ensure continuity of care across PHP/IOP services nationwide.

Competenze

• 2+ years of PHP/IOP utilization review experience 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.
• Ability to work independently in a remote setting.

Mansioni

• 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.

Conoscenze

Utilization review

Insurance authorization

Behavioral health

Strumenti

EMR/EHR platforms

Authorization software

Descrizione del lavoro

Principles Recovery Center is seeking a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult behavioral health, substance use, and co-occurring treatment. This is a remote, full-time role with standard hours 9 AM–5 PM ET, Monday–Friday.

You will verify benefits, complete authorizations, and support medical necessity using ASAM, LOCUS, and CALOCUS, coordinating with clinical teams to ensure continuity of care across PHP/IOP services nationwide.