Utilization & Reimbursement Liaison Specialist

Acadia Healthcare; Ada (OK); On-site; USD 45,000 - 65,000; Full time

Job summary

Acadia Healthcare is seeking an Utilization Review Coordinator in Oklahoma to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations and clinical staff to ensure compliance with certification requirements and medical necessity standards.

You will gather data on utilization, length of stay, and discharges, and assist with pre-certifications and appeal processes.

Qualifications

• Clinical experience is required, or two or more years' experience working with the facility's population.
• Previous experience in utilization management is preferred.
• CPR and de-escalation and restraint certification 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 and coordinate communication concerning reimbursement requirements.
• Monitor patient length of stay and inform clinical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, 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 the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
• Perform other functions and tasks as assigned.

Skills

Clinical experience

Utilization management

Education

High school diploma or equivalent

Associate's/Bachelor's/Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field

Job description

Acadia Healthcare is seeking an Utilization Review Coordinator in Oklahoma to proactively monitor service utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations and clinical staff to ensure compliance with certification requirements and medical necessity standards.

You will gather data on utilization, length of stay, and discharges, and assist with pre-certifications and appeal processes.