Utilization & Reimbursement Specialist

Acadia Healthcare; Battle Creek (MI); On-site; USD 73,000 - 87,000; Full time

Benefits offered by this job

Medical/Dental/Vision plans

HSA with company contribution

FSA dependent care

Life Insurance

Short-Term & Long-Term Disability

401k with company match

Employee Assistance Program (EAP)

Employee discount program

Paid time off: vacation/sick/personal/

8 paid holidays

Tuition reimbursement

Continuing education credits

Paid training

Job summary

Bronson Behavioral Health Hospital in Michigan is hiring a full-time Utilization Specialist to act as a liaison between managed care organizations and the facility's clinical staff, ensuring appropriate utilization and reimbursement.

The role involves reviews for certification, monitoring length of stay, gathering data, coordinating appeals, pre-certifications, and providing staff with training on documentation and medical necessity. Competitive benefits accompany this position.

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 a related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.

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 (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• 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 knowledge

Education

High school diploma or equivalent

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

Job description

Bronson Behavioral Health Hospital in Michigan is hiring a full-time Utilization Specialist to act as a liaison between managed care organizations and the facility's clinical staff, ensuring appropriate utilization and reimbursement.

The role involves reviews for certification, monitoring length of stay, gathering data, coordinating appeals, pre-certifications, and providing staff with training on documentation and medical necessity. Competitive benefits accompany this position.