Utilization Review Specialist - Behavioral Health (Remote)
$24 - $26 per hourPrinciples Recovery Center
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
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 .
- 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.
- Kipu EMR experience.
- Multi-payer SCA, appeals, and denial management experience.
- Familiarity with CPT, ICD-10, and DSM-5 .
- Bilingual English/Spanish.
Vacancy posted 8 hours ago
Similar jobs that could be interesting for youBased on the Utilization Review Specialist - Behavioral Health (Remote) in Davie, FL vacancy
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining... ...ideal candidate has prior utilization review or behavioral health experience, strong knowledge of payer...Remote workPart timeWeekend work
Recovery Unplugged
United States5 days ago - ...Managing insurance authorizations for mental health and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior... ...necessity criteria while working remotely. Key responsibilities Verify insurance...Remote workFull time
Virtual Vocations Inc
United States2 days ago - Optum is seeking a Behavioral Health Utilization Review Specialist to support case management and care coordination remotely. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings. You will collaborate with...Remote jobMonday to Friday
- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals...Remote work
Northpoint-Recovery-Holdings,-LL
Meridian, ID3 days ago - ...Minnesota Adult & Teen Challenge in Minneapolis is seeking a Utilization Review Coordinator to obtain and maintain insurance authorizations for... ...and DHS requirements. Training is provided; initial in-person in Minneapolis with remote work thereafter. #J-18808-Ljbffr...Remote work
MnAdultTeenChallenge
Minneapolis, MN9 hours ago - ...Bradford Health Services seeks an experienced Utilization Review Specialist to join our Birmingham-based team. You will evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriate level of care while ensuring regulatory...Remote work
Addiction And Mental Health Services
United States1 day ago - Minnesota Adult & Teen Challenge is seeking an Utilization Review Coordinator to manage insurance authorizations for treatment services. This role collaborates with admissions, counselors, and payers to ensure timely authorizations and compliance with payer and regulatory...Remote job
- CVS Health Corporation seeks a Behavioral Health Utilization Management Clinician. This remote role prefers Louisiana residency and requires Sunday-Thursday, 8:00 AM-5:00 PM CST. You will review treatment plans, apply guidelines, coordinate with teams, and support crisis...Remote job
- ...Utilization Review SpecialistMesa Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities... ...others. As a Utilization Review Specialist joining our team, you're... ...Mesa SpringsMesa Springs is a behavioral health hospital offering exceptional...Temporary workPart timeRelief
LifePoint Health
Fort Worth, TX4 days ago - ...seeking a licensed clinician to review ABA services and health status across the care... ...and alignment with behavioral health guidelines. The role... ...data analysis to improve utilization, and collaboration with BH... ...is required, with flexible remote/hybrid options. #J-18808-...Remote workFlexible hours
- CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote role nationwide. The position features a 12.5% shift differential, weekend/evening schedule, and holidays. You will review preauthorization requests, coordinate decisions with providers...Remote jobShift workWeekend workAfternoon shift
- ...Pavilion Behavioral Health System in Champaign, Illinois, is seeking a Full-time Utilization Review Coordinator to ensure accurate chart reviews and to obtain hospital stay certifications from insurers. The role supports behavioral health and addiction treatment across...Full time
Laurel Ridge Treatment Center
Champaign, IL3 days ago - ...matters Mesa Springs is part of Lifepoint Health, a diversified healthcare delivery... ...exceptional care to others. As a Utilization Review Specialist joining our team, you're embracing a... ...about Mesa Springs Mesa Springs is a behavioral health hospital offering exceptional...Temporary workPart timeRelief
LifePoint Health
Eastern, KY1 day ago - ...Brynn Marr Hospital in Jacksonville, NC seeks a Utilization Reviewer to assess patient records, determine appropriate levels of care,... ...psychology, sociology, social work, or related fields. Monday–Friday day shift, fast-paced behavioral health environment. #J-18808-Ljbffr...Monday to FridayDay shift
Laurel Ridge Treatment Center
Jacksonville, NC3 days ago - ...Job Description Utilization Review Specialist - Full Time Days - Onsite Your experience matters... ...Mesa Springs is part of Lifepoint Health, a diversified healthcare delivery network... ...about Mesa Springs Mesa Springs is a behavioral health hospital offering exceptional...Full timeTemporary workPart timeRelief
LifePoint Health
Fort Worth, TX5 days ago - ...New Vista Behavioral Health is seeking a detail-oriented Corporate Utilization Review Specialist to support utilization review and insurance authorization processes across multiple behavioral health facilities. Candidates must hold an active clinical license as an RN...
New Vista Behavioral Health
Cincinnati, OH4 days ago - Ambrosia Behavioral Health in West Palm Beach, FL is seeking a seasoned Utilization Review Specialist to join our Revenue Cycle team. You will manage initial and concurrent authorizations and coordinate with payers to ensure medical necessity and appropriate levels of...
- Fuller Hospital in South Attleboro, MA, seeks a full-time Utilization Review Coordinator to monitor effective use of health care resources across inpatient and outpatient behavioral health services. The role interfaces with outside agencies, payers, and managed care companies...Full time
- Skyway Behavioral Healthis an innovative center that goes beyond the treatment of mood... ...for all patients. Role Description Utilization Review Specialist (URS) reports to the Utilization Review... ...services and documented mental health needs. Demonstrates a high level of accuracy...Temporary workLocal area
- ...Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring... ...level of care for Oregon Medicaid in a fully remote role. The position follows a Monday–Friday 8–5 Pacific...Remote workMonday to Friday
Centene Corporation
Eastern, KY1 day ago - ...Centene Corporation is seeking a fully remote Behavioral Health Utilization Review Specialist. The role focuses on evaluating mental health and substance use care, performing prior-authorizations, and conducting concurrent reviews to ensure medically appropriate levels...Remote work
Centene Corporation
United States4 days ago - ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials for a seamless... ...levels of care and timely approvals. This remote role requires PA RN licensure (or multi-state eNLC), a...Remote work
Highmark Health
United States5 days ago - ...Centene Corporation is seeking a remote Behavioral Health Utilization Review Specialist to assess care for mental health and substance use, reviewing authorization requests and inpatient cases across various settings. The role emphasizes collaboration with providers,...Remote work
Centene Corporation
Brooklyn, NY5 days ago - ...Centene is seeking a remote Utilization Review Clinician - Behavioral Health to support Oregon Medicaid. The role requires independent clinical licensure and experience in behavioral health and utilization management. It offers a full-time day-shift schedule and a nationwide...Remote workFull timeDay shift
Centene Corporation
United States2 days ago - ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
CCF
United States1 day ago - ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Remote workWork at office
HealthHelp
United States5 days ago - ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
Cleveland Clinic
United States1 day ago $65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge... ..., we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with strong experience...Remote workMonday to FridayWeekend workWeekday workConcierge Home Care
United States1 day ago- ...Mesa Springs in Fort Worth, TX is seeking a dedicated Utilization Review Specialist to ensure appropriate inpatient and outpatient authorizations, accuracy in denials and certifications, and effective communication with physicians and care teams. You will apply clinical...
LifePoint Health
Eastern, KY1 day ago - ...Evolve Treatment Centers in West Palm Beach, Florida, is seeking a full-time Utilization Review Specialist. This role involves initiating pre-certification authorizations, communicating with facilities, and maintaining patient census. Candidates should have a High School...Full time
Praesum Healthcare
West Palm Beach, FL1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Specialist - Behavioral Health (Remote). Be the first to apply!
Related searches
- mathematics specialist Davie, FL
- configuration specialist Davie, FL
- specialist Davie, FL
- coding specialist Davie, FL
- safety specialist Davie, FL
- housing specialist Davie, FL
- credit specialist Davie, FL
- reconciliation specialist Davie, FL
- gaming specialist Davie, FL
- information technology specialist Davie, FL