Utilization Review Specialist - Behavioral Health (Remote)

Principles Recovery Center; Florida; Remote; USD 33,000 - 36,000; Full time

Job summary

Principles Recovery Center is seeking a remote Utilization Review Specialist to manage insurance authorizations for adolescent and adult behavioral health, PHP, and IOP programs. The role requires 2+ years of UR experience and fluency with ASAM, LOCUS, and CALOCUS criteria.

You will verify benefits, prepare prior authorizations, and coordinate with clinical teams to ensure continuity of care. Proficiency with EMR/EHR and payer communication is essential.

Qualifications

• 2+ years of PHP/IOP utilization review (UR) 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.
• 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

Behavioral health UR

Insurance authorization

Remote work

EMR/EHR proficiency

Payer communication

Case tracking

Tools

EMR/EHR platforms

Authorization software

Kipu EMR

Job description

Utilization Review Specialist - Behavioral Health (Remote)

PHP/IOP | Full-Time | Monday-Friday, 9 AM-5 PM ET | $24-$26/hour

About the Role

Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for adolescent and adult mental health, substance use, and co-occurring treatment.

Required: 2+ years of behavioral health UR/authorization experience supporting Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).

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.

Required 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.

Preferred Qualifications

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

Our Mission

AWA and PRC provide behavioral health PHP/IOP treatment across South Florida. Your work helps clients and families access care and stay connected to treatment.

Learn More: Principles Recovery Center