Utilization & Reimbursement Specialist — Care Coordination

Acadia Healthcare; Knoxville (TN); On-site; USD 52,000 - 86,000; Full time

Job summary

Acadia Healthcare is seeking a qualified professional to proactively monitor utilization of services and optimize reimbursement for our facilities. The role includes liaising with managed care organizations, reviewing plans for certification compliance, and coordinating communication with clinical staff.

Responsibilities also cover monitoring length of stay, gathering data for reporting, and conducting medical necessity reviews.

Qualifications

• Clinical experience required or two+ years working with the facility's population.
• Experience in utilization management preferred.
• CPR and de-escalation certification required.

Responsibilities

• Act as liaison between managed care organizations and facility professional clinical staff.
• Conduct reviews of insurance plans or MCOs and coordinate communication regarding reimbursement requirements.
• Monitor patient length of stay and inform staff on issues impacting stay.

Skills

Clinical experience

Utilization management

CPR certification

De-escalation training

Education

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

Job description

Acadia Healthcare is seeking a qualified professional to proactively monitor utilization of services and optimize reimbursement for our facilities. The role includes liaising with managed care organizations, reviewing plans for certification compliance, and coordinating communication with clinical staff.

Responsibilities also cover monitoring length of stay, gathering data for reporting, and conducting medical necessity reviews.