Utilization Review Specialist (Remote) - Behavioral Health

Remote Authorization Specialist Remote | Full-Time | 9a-5p Monday-Friday | $24-$26/hour About the Role This role manages insurance authorization for clients across our PHP and IOP programs — completing pre-certifications, concurrent reviews, verifying benefits, obtaining Single Case Agreements, and managing appeals so that client access to treatment is never disrupted by a payer issue. Backgrounds that translate well Utilization Review · Insurance Authorization/Precertification · Behavioral Health Case Management What You'll Do Verify benefits and eligibility prior to admission and throughout treatment Complete pre-certifications, concurrent reviews, and re-certifications for PHP/IOP levels of care Obtain Single Case Agreements with out-of-network payers Build the medical necessity case using ASAM, LOCUS, and CALOCUS criteria Prepare and submit appeals on denied authorizations Maintain accurate, audit-ready authorization, denial, and SCA records What We're Looking For 2+ years of experience as a UR/authorization specialist at the PHP and IOP levels of care for a mental health or substance use facility Working knowledge of ASAM, LOCUS, and CALOCUS criteria and medical necessity standards Strong organizational skills with the ability to manage multiple authorizations and deadlines concurrently Strong familiarity with EMR platforms and authorization software Strong written and verbal communication skills, with the ability to advocate effectively with payers Eligible for DCF and AHCA Level 2 Background Check Preferred CPT/ICD-10 and DSM-5 familiarity Multi-payer SCA experience Bilingual (English/Spanish) Kipu or similar EMR experience AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. We exist to serve clients and families at their most critical moments — and this role sits at the front door of that mission. Learn More: Adolescent Wellness Academy · Principles Recovery Center #J-18808-Ljbffr Triwill Group