Utilization & Medical Necessity Liaison

Acadia Healthcare; Springfield (MO); On-site; USD 50,000 - 75,000; Full time

Job summary

Acadia Healthcare in Springfield, MO seeks a utilization management professional to optimize reimbursement through service utilization monitoring. You will liaise with managed care organizations, conduct reviews for medical necessity, monitor length of stay, and prepare reports for leadership.

Responsibilities include facilitating peer reviews, handling pre-certifications, and guiding staff on documentation and stay criteria.

Qualifications

• High school diploma or equivalent required.
• Preferred: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or related field.
• Clinical experience required, or two+ years working with the facility's population; utilization management experience preferred.
• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, or LPC-I as applicable in the state.
• CPR, de-escalation and restraint certification required; first aid may be required.

Responsibilities

• 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 and appeals information.
• 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.

Skills

Clinical experience

Utilization management

Education

High school diploma or equivalent

Associate/Bachelor/Master in health field

Job description

Acadia Healthcare in Springfield, MO seeks a utilization management professional to optimize reimbursement through service utilization monitoring. You will liaise with managed care organizations, conduct reviews for medical necessity, monitor length of stay, and prepare reports for leadership.

Responsibilities include facilitating peer reviews, handling pre-certifications, and guiding staff on documentation and stay criteria.