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 4 days ago
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