Utilization & Reimbursement Specialist

Rebound Behavioral Health Hospital; Lancaster (SC); On-site; USD 45,000 - 65,000; Full time

Job summary

Rebound Behavioral Health Hospital is seeking a utilization management professional to monitor reimbursement processes and ensure compliant, efficient service delivery. The role focuses on coordinating with managed care organizations and ensuring accurate documentation for approvals.

You will review plans for certification, monitor patient length of stay, and gather metrics to inform leadership. The position includes coordinating appeals for denials and training staff on documentation and

Qualifications

• Required: High school diploma or equivalent.
• Preferred: Associate's, Bachelor's, or Master's in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• 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 facility staff.
• Review plans for certification requirements and coordinate communication on reimbursement needs.
• Monitor patient length of stay and inform clinical staff of issues affecting stay.
• Gather and report utilization, non-certified days, discharges, and quality metrics.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between the facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing training for staff on documentation, charting requirements, continued stay criteria, and medical necessity updates.
• Perform other functions as assigned.

Skills

Clinical experience

Utilization management

Staff training

Education

High school diploma or equivalent

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

Job description

Rebound Behavioral Health Hospital is seeking a utilization management professional to monitor reimbursement processes and ensure compliant, efficient service delivery. The role focuses on coordinating with managed care organizations and ensuring accurate documentation for approvals.

You will review plans for certification, monitor patient length of stay, and gather metrics to inform leadership. The position includes coordinating appeals for denials and training staff on documentation and