Utilization Review Specialist – Behavioral/Mental Health | Remote | 13-Week Contract
Remote (Florida)
Supporting Four Behavioral/Mental Health Facilities Throughout Florida
Job Type: 13-Week Contract
Schedule: Monday–Friday | 8:30 AM – 5:00 PM
Openings: 2 Positions Available
Pay: Starting at $28.00 per hour
Job Summary
Pro Med Healthcare Services is seeking experienced Utilization Review Specialists to support behavioral health and mental health facilities throughout Florida. This fully remote contract opportunity is ideal for professionals experienced in insurance authorizations, medical necessity reviews, concurrent reviews, and behavioral health utilization management.
The Utilization Review Specialist serves as a critical liaison between clinical teams and insurance providers, ensuring patients receive the appropriate level of care while maintaining compliance with payer requirements and regulatory standards.
If you have experience working with behavioral health, substance use treatment, psychiatric services, or mental health programs, we encourage you to apply.
What You'll Do
• Conduct utilization reviews to determine medical necessity and appropriate levels of care.
• Complete initial, concurrent, and continued stay reviews with commercial insurance carriers and managed care organizations.
• Obtain and maintain insurance authorizations for behavioral health services.
• Prepare and submit clinical documentation supporting continued stay requests.
• Monitor authorization status and document approvals, denials, and extensions accurately.
• Collaborate with admissions, therapists, nurses, case managers, physicians, and clinical leadership.
• Assist with insurance denials, peer-to-peer reviews, reconsiderations, and appeals.
• Ensure compliance with payer guidelines and accreditation standards including CARF, AHCA, DCF, and applicable state and federal regulations.
• Maintain accurate documentation within the electronic health record (EHR).
• Protect patient confidentiality in accordance with HIPAA regulations.
Required Qualifications
• Bachelor’s degree in Mental Health, Social Work, Psychology, or related field (or equivalent experience).
• 2 years of previous experience in utilization review or insurance authorization preferred.
• Strong knowledge of medical necessity criteria (e.g., ASAM, LOCUS, InterQual).
• Excellent communication, organizational, and time management skills.
• Proficiency in electronic health records and Microsoft Office Suite.
Why Join Pro Med Healthcare Services?
• Competitive Hourly Pay
• Opportunity to support leading behavioral health providers throughout Florida
• Collaborative and supportive clinical team
• Meaningful work that directly impacts patient care and access to treatment
Apply Today and if you have any additional questions please feel free to call us:
Recruiter: Tammy B
Phone: 561-421-8887
Email: [email protected]
Pay: From $28.00 per hour
Application Question(s):
• Do you have a Level 2 AHCA background and fingerprints?
Experience:
• Utilization review: 2 years (Required)
• obtaining insurance authorizations and concurrent reviews: 1 year (Required)
• ASAM, LOCUS, InterQual, or MCG Guidelines: 1 year (Required)
• in Behavioral Health, Mental Health, or Psychology: 1 year (Preferred)
Work Location: Remote