Utilization Review Specialist - Behavioral Health (Remote) Job at Principles Recovery Center, Remote

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  • Principles Recovery Center
  • Remote

Job Description

Utilization Review Specialist – Behavioral Health (Remote)

PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$28/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

  • 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.

Learn More: Principles Recovery Center (

Job Tags

Remote job, Full time, Monday to Friday

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