Utilization & Reimbursement Specialist

Acadia Healthcare; Conway (AR); On-site; USD 42,000 - 64,000; Full time

Job summary

Acadia Healthcare is seeking a professional to proactively monitor service utilization and optimize reimbursement for the facility. You will liaise with managed care organizations, review plans, and coordinate communication on requirements, while monitoring length of stay and reporting on utilization and quality metrics.

The role involves conducting reviews for medical necessity, supporting staff training, and assisting admissions with pre-certifications.

Qualifications

• High school diploma or equivalent required.
• Preferred degrees: Associate, Bachelor’s, or Master’s in social work, behavioral/mental health, nursing, or related field.
• Clinical experience or 2+ years working with the facility population; utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff for reimbursement.
• Conduct reviews per certification requirements of insurance plans and coordinate communication on reimbursement.
• Monitor patient length of stay and inform staff of issues affecting length of stay.
• Gather and report utilization, discharges, and quality information to leadership.

Skills

Clinical experience

Utilization management experience

Experience with facility population

Education

High school diploma or equivalent

Associate/Bachelor/Master in Social Work, Behavioral or Mental Health, Nursing, or related health field

Tools

CPR certification

Job description

Acadia Healthcare is seeking a professional to proactively monitor service utilization and optimize reimbursement for the facility. You will liaise with managed care organizations, review plans, and coordinate communication on requirements, while monitoring length of stay and reporting on utilization and quality metrics.

The role involves conducting reviews for medical necessity, supporting staff training, and assisting admissions with pre-certifications.