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 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