Utilization & Reimbursement Specialist

Acadia Healthcare; Wesley Chapel (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Acadia Healthcare is seeking a Healthcare Utilization Management Specialist to proactively monitor service utilization, coordinate with managed care organizations, and optimize reimbursement for the facility.

You will review plans, support admissions pre-certifications, train staff on documentation, and conduct quality reviews for medical necessity under state and facility requirements. This role is Monday–Friday with 8:00 AM shifts on-site in Florida.

Qualifications

• Education requirement: high school diploma or equivalent.
• Preferred degrees in social work, behavioral/mental health, nursing, or related health field.
• Experience: clinical experience required or 2+ years with facility population; utilization management preferred.
• Licenses: preferred licensure (LPN/RN/LMSW/LCSW/LPC) as required in the service state.
• Certifications: CPR, de-escalation and restraint training required; first aid may be required.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Perform reviews of insurance plans and coordinate communication for reimbursement requirements.
• Monitor patient length of stay and inform staff of issues impacting stay.
• Prepare and report utilization data, discharge information, and quality of services.
• Conduct quality reviews for medical necessity and services.
• Facilitate peer review calls with external organizations.
• Initiate and complete appeal processes for denied admissions or continued stays.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation and charting requirements.

Skills

Clinical experience

Utilization management

CPR and de-escalation

Education

High school diploma or equivalent

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

Job description

Acadia Healthcare is seeking a Healthcare Utilization Management Specialist to proactively monitor service utilization, coordinate with managed care organizations, and optimize reimbursement for the facility.

You will review plans, support admissions pre-certifications, train staff on documentation, and conduct quality reviews for medical necessity under state and facility requirements. This role is Monday–Friday with 8:00 AM shifts on-site in Florida.