Utilization Review Specialist – Behavioral Health

This is a fully remote position, open to applicants in Florida.

📋 Description

• Validate insurance benefits, eligibility, and coverage criteria

• Process prior authorizations, pre-certifications, concurrent reviews, and continued-stay assessments

• Support medical necessity using ASAM, LOCUS, and CALOCUS guidelines

• Secure Single Case Agreements (SCAs) with out-of-network insurers

• Handle denial appeals and organize peer-to-peer evaluations

• Monitor authorized units, coverage periods, and payer deadlines

• Collaborate with clinical and admissions teams to ensure continuity of care

• Keep precise authorization records in the EMR/EHR system

⛳️ Requirements

• A minimum of 2 years of PHP/IOP utilization review, utilization management, or insurance authorization experience in a behavioral health setting

• Familiarity with ASAM, LOCUS, CALOCUS, and medical necessity criteria

• Proven experience in communicating with insurance providers and managed care organizations

• Strong skills in case tracking, documentation, organization, and payer advocacy

• Proficient in EMR/EHR systems and authorization software

• Capable of working independently in a remote environment

• Eligibility for DCF and AHCA Level 2 background checks

• Preferred: Experience with Kipu EMR

• Preferred: Experience in multi-payer SCA, appeals, and denial management

• Preferred: Knowledge of CPT, ICD-10, and DSM-5

• Preferred: Bilingual in English and Spanish

🏝️ Benefits

• Comprehensive health, dental, and vision insurance

• Retirement savings plan with company match

• Generous paid time off and holiday schedule

• Opportunities for professional development and training