Healthcare Utilization & Reimbursement Specialist

Acadia Healthcare; Nashville (TN); On-site; USD 55,000 - 75,000; Full time

Job summary

Acadia Healthcare in Nashville, TN is seeking a utilization management professional to monitor service utilization and optimize reimbursement for the facility. The role acts as a liaison between managed care organizations and clinical staff, reviews plans for certification requirements, and coordinates communications related to reimbursement and continued stay criteria.

The candidate will have clinical experience (or 2+ years working with the facility’s population) and preferably a background in

Qualifications

• High school diploma or equivalent.
• Clinical experience required, or 2+ years working with the facility population.
• Experience in utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Review plans for certification requirements and coordinate reimbursement communication.
• Monitor patient length of stay and inform staff of issues impacting length of stay.
• Gather statistical and narrative information to report on utilization, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls with external organizations.
• Initiate and complete the formal appeal process for denied admissions.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation, continued stay criteria, and medical necessity updates.
• Perform other duties as assigned.

Skills

Clinical experience

Utilization management

Communication skills

Liaison skills

Education

High school diploma

Social Work degree

Job description

Acadia Healthcare in Nashville, TN is seeking a utilization management professional to monitor service utilization and optimize reimbursement for the facility. The role acts as a liaison between managed care organizations and clinical staff, reviews plans for certification requirements, and coordinates communications related to reimbursement and continued stay criteria.

The candidate will have clinical experience (or 2+ years working with the facility’s population) and preferably a background in