Behavioral Health Utilization Review Specialist
Job Summary
Managing insurance authorizations for mental health and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely.
Key responsibilities
- Verify insurance benefits, eligibility, and coverage requirements
- Complete prior authorizations, pre-certifications, and concurrent reviews
- Collaborate with clinical teams to support continuity of care
Required qualifications
- 2+ years of PHP/IOP utilization review or insurance authorization experience
- Knowledge of ASAM, LOCUS, CALOCUS, and medical necessity standards
- Experience communicating with insurance payers and managed care organizations
- Proficiency with EMR/EHR platforms and authorization software
- Eligibility for DCF and AHCA Level 2 background screening
Complete Job Description
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