Utilization & Care Coordination Specialist

Acadia Healthcare; Ocklawaha (FL); On-site; USD 27,552 - 33,062; Full time

Job summary

The Refuge, a Healing Place in Ocklawaha, Florida, part of Acadia Healthcare, is seeking a Full Time Utilization Review Specialist. You will monitor utilization of services to optimize reimbursement and support clinical staff with documentation and pre-certifications.

This 40-hour per week, Monday–Friday day position involves liaising with managed care organizations, reviewing plans for medical necessity, tracking length of stay, and initiating appeal processes for denied admissions.

Qualifications

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor’s, or Master’s in Social Work or related field.
• Experience: Clinical experience required or 2+ years in the facility's population; utilization mgmt preferred.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and coordinate reimbursement communication.
• Monitor length of stay and inform staff of issues affecting stay.
• Gather data to report utilization, non-certified days, discharges and quality.
• Conduct reviews for medical necessity and services provided.
• Facilitate peer review calls and manage appeal processes for denials.
• Assist admissions with pre-certifications and train staff on documentation.
• Perform other tasks as assigned.

Skills

Clinical experience

Utilization management

Liaison with MCOs

Education

High School Diploma or equivalent

Advanced health degree (preferred)

Job description

The Refuge, a Healing Place in Ocklawaha, Florida, part of Acadia Healthcare, is seeking a Full Time Utilization Review Specialist. You will monitor utilization of services to optimize reimbursement and support clinical staff with documentation and pre-certifications.

This 40-hour per week, Monday–Friday day position involves liaising with managed care organizations, reviewing plans for medical necessity, tracking length of stay, and initiating appeal processes for denied admissions.