Utilization & Reimbursement Specialist

Harboroaks; Brooksville (FL); On-site; USD 23,000 - 32,000; Full time

Job summary

Sabal Palms Recovery Center in Brooksville, FL seeks a Full Time Utilization Review Specialist. You will monitor service utilization, coordinate reimbursement, and support clinical and admissions teams to optimize patient care and facility revenue.

Responsibilities include reviewing plans, tracking length of stay, compiling reports, and guiding staff on medical necessity and documentation. Join a dedicated team on a 40-hour Mon-Fri schedule with competitive pay.

Qualifications

• High school diploma or equivalent is required.
• Clinical experience or 2+ years with the facility's population.
• CPR and de-escalation certification required.
• First aid may be required per state or facility requirements.

Responsibilities

• Act as liaison between MCOs and facility staff.
• Conduct reviews of insurance plans for reimbursement requirements.
• Monitor length of stay and extensions and inform staff of issues.
• Gather and report statistics on utilization, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls with 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 and criteria.

Skills

Liaison with MCOs

Reimbursement coordination

Data gathering & reporting

Education

High school diploma or equivalent

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

Tools

Utilization review software

Job description

Sabal Palms Recovery Center in Brooksville, FL seeks a Full Time Utilization Review Specialist. You will monitor service utilization, coordinate reimbursement, and support clinical and admissions teams to optimize patient care and facility revenue.

Responsibilities include reviewing plans, tracking length of stay, compiling reports, and guiding staff on medical necessity and documentation. Join a dedicated team on a 40-hour Mon-Fri schedule with competitive pay.