Utilization & Reimbursement Specialist

Acadia Healthcare; Allenwood (PA); On-site; USD 55,000 - 70,000; Full time

Job summary

Acadia Healthcare in Pennsylvania seeks a utilization management professional to monitor service utilization and coordinate reimbursement at our facility. You will liaise between managed care organizations and clinical staff, review plans for medical necessity, and support admissions with pre-certifications.

The role emphasizes teamwork, documentation, and compliance in a acute care setting. Required: high school diploma; preferred: associate's or higher in social work or related field; clinical

Qualifications

• Clinical experience required or 2+ years with the facility's population.
• Preferred utilization management experience.
• Licensure in state where services are provided preferred.

Responsibilities

• Act as liaison between MCOs and clinical staff.
• Review insurance plans for medical necessity and reimbursement.
• Monitor length of stay and communicate issues to staff.
• Support admissions with pre-certifications and appeals as needed.
• Provide staff training on documentation and updated criteria.

Skills

Clinical experience

Utilization management

Documentation

Education

High school diploma or equivalent

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

Tools

CPR

First aid

Job description

Acadia Healthcare in Pennsylvania seeks a utilization management professional to monitor service utilization and coordinate reimbursement at our facility. You will liaise between managed care organizations and clinical staff, review plans for medical necessity, and support admissions with pre-certifications.

The role emphasizes teamwork, documentation, and compliance in a acute care setting. Required: high school diploma; preferred: associate's or higher in social work or related field; clinical