Utilization Specialist

Acadia Healthcare; Brooksville (FL); On-site; USD 40,000 - 52,000; Full time

Job summary

Sabal Palms Recovery Center in Brooksville, Florida is seeking a Full Time Utilization Review Specialist to monitor utilization of services and optimize reimbursement. The role supports the facility's treatment program for adults 18 and older.

Schedule: Monday–Friday, 40 hours weekly; pay starts at $20 and increases with experience. Responsibilities include liaising with managed care, performing reviews, tracking length of stay, and ensuring medical necessity and proper documentation.

Qualifications

• High school diploma or equivalent required.
• Clinical experience or 2+ years in healthcare utilization management preferred.
• Certification in CPR and de-escalation may be required.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans for reimbursement requirements.
• Monitor length of stay and inform staff of issues affecting stays.
• Gather data and report utilization, discharges and quality of services.
• Conduct quality reviews for medical necessity and services.
• Facilitate peer review calls and manage admissions appeals.
• Assist admissions with pre-certifications and staff training on docs.
• Perform other duties as assigned.

Skills

Utilization review

Healthcare documentation

Communication

Education

High school diploma or equivalent

Associate's degree in Social Work or related field

Bachelor's degree in Social Work or related field

Master's degree in related field

Job description

Are you prepared for the impact you can make in your UR career at a well-respected treatment center in Brooksville, Florida? If so, you may enjoy working at Sabal Palms Recovery Center, an addiction treatment facility nestled on a 10-acre campus located along Florida's Nature Coast and surrounded by live oak trees. Sabal Palms Recovery Center provides premier residential treatment for adults aged 18 and older who are struggling with addictions.
We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility.
Schedule: Monday - Friday, 40 hour week - benefit-eligible
Pay: Pay for this position starts at $20 and increases based on relevant experience
Essential Functions

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
• Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
• Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
• 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 or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

Other Functions

• Perform other functions and tasks as assigned.

Education/Experience/Skill Requirements

• Required Education: High school diploma or equivalent.
• Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
• Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

Licenses/Designations/Certifications

• CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
• First aid may be required based on state or facility requirements.

Additional Regulatory RequirementsWhile this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
This position requires a Level 2 Background Screening through the Florida Care Provider Background Screening Clearinghouse. In accordance with Florida law, employers must provide applicants with direct access to information about the state’s background screening requirements.
AboutTo learn more about disqualifying offenses, exemption procedures and screening timelines, please visit the Agency for Health Care Administration (AHCA) Background Screening Education & Awareness webpage:
https://info.flclearinghouse.com/education-awareness
SPRC