Part-Time Utilization Specialist: Reimbursement & Care

Acadia Healthcare; Memphis (TN); On-site; USD 60,000 - 80,000; Full time

Job summary

Acadia Healthcare seeks a utilization management professional in Memphis to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations, conducting plan reviews, and guiding staff on documentation and stay criteria.

Required clinical experience with the facility population, plus preferred licensure (LPN/RN/LMSW/LCSW/LPC). CPR and restraint certification may be required; 2+ years in UM is desirable.

Qualifications

• High school diploma or equivalent required.
• Clinical experience required, or 2+ years with the facility's population.
• Preferred licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I in the state of practice.
• CPR and de-escalation/ restraint certification required (training available on hire).
• Experience in utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff.
• Conduct reviews of insurance plans and communicate reimbursement requirements.
• Monitor patient length of stay and inform staff of Stay-related issues.
• Gather and develop data on utilization, non-certified days, discharges and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation, stay criteria, and medical necessity updates.

Skills

Clinical experience

Utilization management

Liaison skills

Education

High school diploma

Associate's degree

Bachelor's degree

Master's degree

Job description

Acadia Healthcare seeks a utilization management professional in Memphis to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations, conducting plan reviews, and guiding staff on documentation and stay criteria.

Required clinical experience with the facility population, plus preferred licensure (LPN/RN/LMSW/LCSW/LPC). CPR and restraint certification may be required; 2+ years in UM is desirable.