Strategic Utilization & Reimbursement Specialist

Acadia Healthcare; Greenville (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Acadia Healthcare is seeking a Utilization Management professional to monitor service utilization and optimize facility reimbursement. You will liaise with managed care organizations and clinical staff to ensure compliance with certification requirements and medical necessity.

The role requires clinical experience in a health care setting, with preferred licensure such as LPN, RN, LMSW, LCSW, or LPC. You will participate in pre-certifications and provide staff training on documentation and stay

Qualifications

• Clinical experience in a health care setting is required.
• Experience with utilization management is preferred.
• Preferred licensure includes LPN, RN, LMSW, LCSW, or LPC as applicable.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans or MCOs and coordinate reimbursement requirements.
• Monitor length of stay and inform staff of issues affecting stay.
• Gather and report statistics 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, continued stay criteria and medical necessity updates.
• Perform other functions as assigned.

Skills

Utilization management

Clinical experience

Communication skills

Education

High school diploma or equivalent

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

Job description

Acadia Healthcare is seeking a Utilization Management professional to monitor service utilization and optimize facility reimbursement. You will liaise with managed care organizations and clinical staff to ensure compliance with certification requirements and medical necessity.

The role requires clinical experience in a health care setting, with preferred licensure such as LPN, RN, LMSW, LCSW, or LPC. You will participate in pre-certifications and provide staff training on documentation and stay