PRN Utilization & Denial Management Specialist

Acadia Healthcare; Saddlebrooke (AZ); On-site; USD 34,440,000 - 55,104,000; Full time

Job summary

Harboroaks is seeking a PRN Utilization Management Specialist to proactively monitor service utilization and optimize reimbursement for the facility. The role supports the Utilization Management Department during staff absences, heavy census, and other staffing needs, including insurance authorization, concurrent reviews, appeals, and denial management.

PRN availability: Monday–Friday, 8:00am–4:30pm, with some weekends.

Qualifications

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

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff.
• Conduct reviews of insurance plans and coordinate communication on reimbursement requirements.
• Monitor length of stay and extensions; inform staff of issues impacting stay.
• Compile statistical and narrative information to report 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 support and training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.

Education

High school diploma or equivalent

Associate's/Bachelor's/Master's in Social Work/Behavioral or Mental Health/Nursing

Clinical experience in utilization management or related field

Job description

Harboroaks is seeking a PRN Utilization Management Specialist to proactively monitor service utilization and optimize reimbursement for the facility. The role supports the Utilization Management Department during staff absences, heavy census, and other staffing needs, including insurance authorization, concurrent reviews, appeals, and denial management.

PRN availability: Monday–Friday, 8:00am–4:30pm, with some weekends.