Utilization & Reimbursement Specialist

Acadia Healthcare; Wilmington (NC); On-site; USD 45,000 - 75,000; Full time

Job summary

Acadia Healthcare in Wilmington, NC seeks a utilization management professional to monitor service utilization and optimize reimbursements for the facility.

You will liaise with managed care organizations, review plans for certification, support admissions, and train staff on documentation and continued stay criteria.

Clinical experience required; state licensure preferred; CPR certification may be required. This role is on-site in Wilmington, NC.

Qualifications

• High school diploma or equivalent required.
• Clinical experience or 2+ years working with the facility's population; utilization management experience preferred.
• State-appropriate licensure (LPN/RN/LMSW/LCSW/LPC or equivalent); CPR certification preferred.

Responsibilities

• Act as liaison between managed care organizations and facility staff for reimbursement.
• Review plans for certification requirements and coordinate related communications.
• Monitor patient length of stay and inform staff of factors impacting stay.
• Gather data on utilization, discharges, and quality of services for leadership review.
• Conduct quality reviews for medical necessity and services.
• Facilitate peer review calls with 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 on documentation and continued stay criteria.

Skills

Clinical experience

Utilization management

Documentation & charting

Staff training & support

Education

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

Job description

Acadia Healthcare in Wilmington, NC seeks a utilization management professional to monitor service utilization and optimize reimbursements for the facility.

You will liaise with managed care organizations, review plans for certification, support admissions, and train staff on documentation and continued stay criteria.

Clinical experience required; state licensure preferred; CPR certification may be required. This role is on-site in Wilmington, NC.