Utilization & Reimbursement Specialist

Acadia Healthcare; San Juan (PR); On-site; USD 52,000 - 70,000; Full time

Job summary

Acadia Healthcare seeks a qualified professional to oversee utilization management and coordination between managed care organizations and facility staff. You will monitor length of stay, review medical necessity, and support the admissions process.

The role requires clinical experience and may involve training staff on documentation and appeal procedures. This position emphasizes compliant utilization of services and communication with external organizations.

Qualifications

• Required education: high school diploma or equivalent.
• Preferred education: Associate/Bachelor’s/Master’s in social work or related health field.
• Clinical experience required, or 2+ years with the facility's population; utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and the facility clinical staff.
• Conduct reviews of insurance plans and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform staff of factors affecting stay.
• Gather and report statistics on utilization, discharges, and quality of services.
• Perform quality reviews for medical necessity and services.
• Facilitate peer review calls with external organizations.
• Initiate and complete the formal appeal process for denied admissions.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation and medical necessity updates.

Skills

Clinical experience

Utilization management

Communication skills

Education

High school diploma or equivalent

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

Job description

Acadia Healthcare seeks a qualified professional to oversee utilization management and coordination between managed care organizations and facility staff. You will monitor length of stay, review medical necessity, and support the admissions process.

The role requires clinical experience and may involve training staff on documentation and appeal procedures. This position emphasizes compliant utilization of services and communication with external organizations.