Strategic Utilization & Reimbursement Specialist

Acadia Healthcare; Henderson (NV); On-site; USD 55,000 - 70,000; Full time

Job summary

Acadia Healthcare in Henderson, NV seeks a role focused on monitoring utilization of services to optimize facility reimbursement. You will liaise between managed care organizations and clinical staff, conduct plan reviews, and coordinate communication on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering data for reports, performing quality reviews for medical necessity, and supporting admissions with pre-certifications.

Qualifications

• Clinical experience is required, or two or more years' experience with the facility population.
• Experience in utilization management is preferred.
• Preferred licensure or certification aligned with state requirements.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Review insurance plans and coordinate reimbursement communication.
• Monitor length of stay and inform staff of issues impacting stay.
• Gather data for utilization, discharges, and service quality reports.
• Conduct quality reviews for medical necessity and services rendered.
• Support admissions with pre-certifications and training for staff on charting.

Skills

Clinical experience

Utilization management

Education

High school diploma or equivalent

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

Job description

Acadia Healthcare in Henderson, NV seeks a role focused on monitoring utilization of services to optimize facility reimbursement. You will liaise between managed care organizations and clinical staff, conduct plan reviews, and coordinate communication on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering data for reports, performing quality reviews for medical necessity, and supporting admissions with pre-certifications.