Utilization Management & Reimbursement Specialist

Acadia Healthcare; El Paso (TX); On-site; USD 45,000 - 70,000; Full time

Job summary

Acadia Healthcare in El Paso, TX seeks a utilization management professional to act as liaison between managed care organizations and facility staff, reviewing plans and coordinating reimbursement requirements. You will monitor patient length of stay and inform clinical teams of issues impacting stays, while gathering data on utilization and quality of services.

The role requires clinical experience and a preference for licensing in relevant health fields.

Qualifications

• High school diploma or equivalent required.
• Clinical experience with the facility population or 2+ years in utilization management preferred.
• Licensure in LPN, RN, LMSW, LCSW, LPC, or LPC-I preferred per state requirements.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Review insurance plans for certification and coordinate reimbursement requirements.
• Monitor length of stay and inform staff of issues affecting stay.
• Prepare reports on utilization, non-certified days, discharges and quality of services.
• Conduct quality reviews for medical necessity and services.
• Facilitate peer review calls with external organizations.
• Initiate and complete formal appeal processes for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation requirements and continued stay criteria.

Skills

Clinical experience

Utilization management

Communication with MCOs

Documentation training

Education

High school diploma or equivalent

Social Work / Behavioral Health / Nursing degree

Job description

Acadia Healthcare in El Paso, TX seeks a utilization management professional to act as liaison between managed care organizations and facility staff, reviewing plans and coordinating reimbursement requirements. You will monitor patient length of stay and inform clinical teams of issues impacting stays, while gathering data on utilization and quality of services.

The role requires clinical experience and a preference for licensing in relevant health fields.