Utilization Management Specialist

Acadia Healthcare; Springfield (MO); On-site; USD 60,000 - 80,000; Full time

Job summary

Acadia Healthcare seeks a utilization management professional to coordinate between managed care organizations and facility clinicians, ensuring timely reviews and communications for reimbursement. The role includes monitoring patient stay lengths, gathering utilization data, and supporting pre-certifications.

Candidates should have clinical experience and preferably background in utilization management; CPR/first aid may be required and ongoing staff training will be provided.

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+ years in the facility population; utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff.
• Conduct reviews per certification requirements and coordinate reimbursement communication.
• Monitor length of stay and inform staff on issues affecting stay.
• Gather data to report 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, stay criteria, and medical necessity updates.

Skills

Clinical experience

Utilization management

Education

High school diploma or equivalent

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

Job description

Acadia Healthcare seeks a utilization management professional to coordinate between managed care organizations and facility clinicians, ensuring timely reviews and communications for reimbursement. The role includes monitoring patient stay lengths, gathering utilization data, and supporting pre-certifications.

Candidates should have clinical experience and preferably background in utilization management; CPR/first aid may be required and ongoing staff training will be provided.