Utilization & Reimbursement Liaison

Acadia Healthcare; Río Piedras (PR); On-site; USD 50,000 - 80,000; Full time

Job summary

Harboroaks is seeking a healthcare professional to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaison work with managed care organizations and the clinical staff to ensure timely, compliant patient care and case management.

The candidate will conduct plan reviews, monitor length of stay, gather data, and perform medical necessity reviews. Experience in utilization management is preferred, with emphasis on documentation and

Qualifications

• Requires clinical experience or two+ years working with the facility's population.
• Preferred experience in utilization management.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and MCOs to coordinate reimbursement requirements.
• Monitor patient length of stay and inform staff on associated issues.
• Gather data to report utilization, discharges and quality of care metrics.
• Perform 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.
• Perform other duties as assigned.

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

Harboroaks is seeking a healthcare professional to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaison work with managed care organizations and the clinical staff to ensure timely, compliant patient care and case management.

The candidate will conduct plan reviews, monitor length of stay, gather data, and perform medical necessity reviews. Experience in utilization management is preferred, with emphasis on documentation and