Utilization Review Specialist – Behavioral Health (Remote)

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

About the Role

(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.

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