Utilization & Reimbursement Specialist

Acadia Healthcare; Greenville (NC); On-site; USD 55,000 - 75,000; Full time

Job summary

Harboroaks in Greenville, NC is seeking a utilization management coordinator to proactively monitor service utilization and optimize reimbursement for the facility. The role includes acting as a liaison between managed care organizations and clinical staff, conducting reviews, and coordinating reimbursement communications.

The candidate will monitor patient length of stay, gather data on utilization and quality of services, and support staff with documentation and medical necessity updates.

Qualifications

• High school diploma or equivalent required, health-related degrees preferred.
• Clinical experience or 2+ years in utilization management.
• Experience coordinating with managed care organizations and facility staff.

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff.
• Review insurance plans for compliance with certification requirements and coordinate communications.
• Monitor length of stay and inform staff on factors affecting stays.
• Gather statistical data on utilization, discharges and quality of care as required.
• Conduct medical necessity reviews and facilitate peer communications with external organizations.
• Initiate and complete appeals for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation, stay criteria, and medical necessity updates.

Skills

Clinical experience

Utilization management

Training staff

Documentation

Education

High school diploma or equivalent

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

Job description

Harboroaks in Greenville, NC is seeking a utilization management coordinator to proactively monitor service utilization and optimize reimbursement for the facility. The role includes acting as a liaison between managed care organizations and clinical staff, conducting reviews, and coordinating reimbursement communications.

The candidate will monitor patient length of stay, gather data on utilization and quality of services, and support staff with documentation and medical necessity updates.