Utilization Review Specialist – Behavioral Health

Adolescent Wellness Academy

. Verify insurance benefits, eligibility, and coverage requirements .

Posted 10/5/2026full-timeRemote • Florida • United StatesJuniorMid-Level💰 $24 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in insurance authorization processes, including prior authorizations and appeals, while ensuring compliance with medical necessity standards such as ASAM, LOCUS, and CALOCUS. Proficient in utilizing EMR/EHR systems for accurate documentation and case tracking in a behavioral health setting.

Highest-signal resume keywords

Utilization Review ExperienceKnowledge of ASAM, LOCUS, CALOCUSEMR/EHR ProficiencyInsurance Payer CommunicationCase Tracking and Documentation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementPrior AuthorizationsMedical Necessity StandardsDenial ManagementCPT KnowledgeICD-10 KnowledgeDSM-5 FamiliaritySingle Case AgreementsPeer-to-Peer ReviewsBehavioral Health Experience

Soft Skills

Organization SkillsAdvocacy SkillsIndependent Work AbilityCollaboration Skills

Tools & Technologies

EMR SystemsEHR PlatformsAuthorization SoftwareKipu EMR

Certifications & Qualifications

DCF Background Screening EligibilityAHCA Level 2 Background Screening Eligibility

Industry Keywords

Behavioral HealthManaged Care OrganizationsInsurance AuthorizationPayer AdvocacyContinuity of Care

Tech Stack

Tools & technologies

PHP

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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: Kipu EMR experience
Preferred: Multi-payer SCA, appeals, and denial management experience
Preferred: Familiarity with CPT, ICD-10, and DSM-5
Preferred: Bilingual English/Spanish