Utilization Specialist

Harboroaks; Brooksville (FL); On-site; USD 23,000 - 32,000; Full time

Job summary

Sabal Palms Recovery Center in Brooksville, FL seeks a Full Time Utilization Review Specialist. You will monitor service utilization, coordinate reimbursement, and support clinical and admissions teams to optimize patient care and facility revenue.

Responsibilities include reviewing plans, tracking length of stay, compiling reports, and guiding staff on medical necessity and documentation. Join a dedicated team on a 40-hour Mon-Fri schedule with competitive pay.

Qualifications

• High school diploma or equivalent is required.
• Clinical experience or 2+ years with the facility's population.
• CPR and de-escalation certification required.
• First aid may be required per state or facility requirements.

Responsibilities

• Act as liaison between MCOs and facility staff.
• Conduct reviews of insurance plans for reimbursement requirements.
• Monitor length of stay and extensions and inform staff of issues.
• Gather and report statistics on utilization, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• 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 staff training on documentation and criteria.

Skills

Liaison with MCOs

Reimbursement coordination

Data gathering & reporting

Education

High school diploma or equivalent

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

Tools

Utilization review software

Job description

Overview

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

Responsibilities

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.

Qualifications

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 REQUIREMENTS:

While 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 equalemployment 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.

To 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

Applicants are encouraged to review these requirements before applying.

SPRC