Utilization Review Specialist (Remote) - Behavioral Health

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.

Responsibilities

• 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

Requirements

• 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 Qualifications

• CPT/ICD-10 and DSM-5 familiarity
• Multi-payer SCA experience
• Bilingual (English/Spanish)
• Kipu or similar EMR experience

Pay

$24-$26/hour

Schedule

Full-Time, 9a-5p Monday-Friday (Remote)

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.