Strategic Utilization & Reimbursement Specialist

Acadia Healthcare; Tucson (AZ); Sur place; USD 70 000 - 100 000; Plein temps

Résumé du poste

Acadia Healthcare seeks a utilization management professional to proactively monitor service utilization and optimize reimbursement for the facility. You will liaise with managed care organizations and clinical staff, review plans for medical necessity, and coordinate appeals when needed.

You will gather data, monitor length of stay, and support admissions with pre-certifications while providing ongoing staff training on documentation and criteria updates.

Qualifications

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.
• Licensure: Preferred licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification.
• CPR and de‑escalation and restraint certification required (training available upon hire).

Responsabilités

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop 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 the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Perform other functions as assigned.

Connaissances

Clinical experience

Utilization management

Communication with MCOs

Staff training

Formation

High school diploma or equivalent

Associate's/Bachelor's/Master’s in Social Work or related health field

Description du poste

Acadia Healthcare seeks a utilization management professional to proactively monitor service utilization and optimize reimbursement for the facility. You will liaise with managed care organizations and clinical staff, review plans for medical necessity, and coordinate appeals when needed.

You will gather data, monitor length of stay, and support admissions with pre-certifications while providing ongoing staff training on documentation and criteria updates.