Utilization Review Specialist – Behavioral Health

🔥 13 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $24 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Adolescent Wellness Academy

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2015

🏥 Healthcare

🧘 Wellness

Healthcare • Mental Health • Wellness

Adolescent Wellness Academy is a mental health treatment center dedicated to supporting teenagers aged 13-17 and their families. With locations in Broward and Miami-Dade, the academy offers specialized programs including outpatient treatment, intensive outpatient programs, and therapeutic day programs. Their evidence-based approach focuses on addressing various teen mental health issues such as depression, anxiety, self-harm, and substance abuse, while also providing family-centered support to foster lasting positive changes.

📋 Description

• 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

• 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