Utilization Review Specialist - Impactful Care & Growth

Acadia Healthcare; Navarre (FL); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

Life insurance

Short Term and Long Disability

401(k) retirement savings plan with公司匹

FSA and HSA

Employee Assistance Program

Tuition Reimbursement Program

Growth Opportunities

Paid time off

8 Paid annual holidays

Job summary

Acadia Healthcare seeks a Full Time Utilization Review Specialist in Navarre, FL. The role monitors service utilization to optimize reimbursement, with a 40-hour workweek, Monday–Friday, day shift.

You will liaise with managed care and clinical staff, review plans for medical necessity and coordinate communications on approvals and denials. The position requires clinical experience (or 2+ years with the facility's population) and preferred licensure/CPR credentials.

Qualifications

• Clinical experience is required, or two+ years working with the facility's population.
• Utilization management experience is preferred.
• CPR and de-escalation/ restraint training preferred; state requirements may apply.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and coordinate reimbursement communications.
• Monitor length of stay and inform staff of issues affecting stay duration.
• Gather stats and narratives to report utilization, discharges and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between facility and 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 stay criteria updates.

Skills

Clinical experience

Utilization management experience

Communication skills

Education

High school diploma or equivalent

Associate/Bachelor/Master in Social Work, Behavioral or Mental Health, Nursing, or related health field

Job description

Acadia Healthcare seeks a Full Time Utilization Review Specialist in Navarre, FL. The role monitors service utilization to optimize reimbursement, with a 40-hour workweek, Monday–Friday, day shift.

You will liaise with managed care and clinical staff, review plans for medical necessity and coordinate communications on approvals and denials. The position requires clinical experience (or 2+ years with the facility's population) and preferred licensure/CPR credentials.