Utilization Review Specialist – Behavioral Health
利用审查专家 （远程）PHP/IOP ◎全职 ◎星期一~周五，上午9点5分 ET %24$ $26/小时 关于角色原则恢复中心 (PRC) 正在聘请使用评估专家 (UR) 来管理青少年和成人心理健康的保险授权，药物使用和随访治疗。需要：2年以上行为卫生 UR /认证经验支持部分医院治疗计划 (PHP) 和强迫患者计划 (IOP).责任 · 检查保险福利，资格和覆盖要求。· 完成许可，预备证，前期审查和持续住宿审查。· 通过 ASAM,LOCUS 和 CALOCUS 标准支持医疗需求。· 与网络外支付者取得单案协议 (SCAs). ·提交拒绝请求并协调对等审查。·跟踪授权单位，覆盖日期和支付人截止日期。·与临床和录取团队合作以支持持续的护理。·在 EMR/EHR 中保持准确的授权记录。所需资格 · 2年以上 PHP/IOP 利用评估，利用管理或保险授权经验在行为健康设施中。·了解 ASAM ,LOCUS,CALOCus 和医学必要性标准。·与保险付款人和管理护理组织沟通经验。· 强大的案例跟踪，文档，组织和支付人倡导技能。· 对 EMR/EHR 平台和授权软件的熟练知识。· 在远程环境中独立工作的能力。· 资格接受 DCF 和 AHCA 级2背景查。优先资格 · Kipu EMR 经验。• 多付款 SCA,上诉和拒绝管理经验。更多信息：原则恢复中心薪水：24美元28美元/小时原始发布在喜马拉雅山脉
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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
Salary: $24 – $28 / hourOriginally posted on Himalayas