On-Site Utilization & Reimbursement Specialist

Harboroaks; Ocklawaha (FL); On-site; USD 23,000 - 32,000; Full time

Job summary

Harboroaks seeks a full-time Utilization Review Specialist to monitor service utilization and help optimize reimbursement for the facility. This on-site role supports clinical staff and partners with managed care organizations.

Qualifications include at least a high school diploma; preferred degrees in social work or health fields; two+ years in behavioral health; CPR and related certifications are required. Pay starts at $20/hr, with higher starts for relevant education or experience.

Qualifications

• High school diploma or equivalent required.
• Preferred degrees: Associate's, Bachelor's, or Master's in Social Work, Behavioral/Mental Health, Nursing or related field.
• Clinical experience is required; two+ years in behavioral health; utilization management experience preferred.

Responsibilities

• Act as liaison between managed care organizations and clinical staff.
• Review insurance plans and coordinate reimbursement requirements.
• Monitor length of stay and extensions; alert staff to issues.
• Gather data to report utilization, discharges and quality.
• Conduct medical-necessity reviews of services.
• Facilitate peer review calls with external partners.
• Initiate appeals for denied admissions or stays.
• Assist admissions with pre-certifications.
• Train staff on documentation and stay criteria.
• Perform other duties as assigned.

Education

High school diploma or equivalent

Associate's degree, Bachelor's or Master's in Social Work, Behavioral or Mental Health, Nursing, or related health field

Job description

Harboroaks seeks a full-time Utilization Review Specialist to monitor service utilization and help optimize reimbursement for the facility. This on-site role supports clinical staff and partners with managed care organizations.

Qualifications include at least a high school diploma; preferred degrees in social work or health fields; two+ years in behavioral health; CPR and related certifications are required. Pay starts at $20/hr, with higher starts for relevant education or experience.