Utilization Review Specialist

Remote Authorization SpecialistThis 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.Utilization Review · Insurance Authorization/Precertification · Behavioral Health Case ManagementVerify benefits and eligibility prior to admission and throughout treatmentComplete pre-certifications, concurrent reviews, and re-certifications for PHP/IOP levels of careObtain Single Case Agreements with out-of-network payersBuild the medical necessity case using ASAM, LOCUS, and CALOCUS criteriaPrepare and submit appeals on denied authorizationsMaintain accurate, audit-ready authorization, denial, and SCA recordsRequired2+ years of experience as a UR/authorization specialist at the PHP and IOP levels of care for a mental health or substance use facilityWorking knowledge of ASAM, LOCUS, and CALOCUS criteria and medical necessity standardsStrong organizational skills with the ability to manage multiple authorizations and deadlines concurrentlyStrong familiarity with EMR platforms and authorization softwareStrong written and verbal communication skills, with the ability to advocate effectively with payersEligible for DCF and AHCA Level 2 Background CheckPreferredCPT/ICD-10 and DSM-5 familiarityMulti-payer SCA experienceBilingual (English/Spanish)Kipu or similar EMR experienceAWA 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.