Utilization Specialist (100% onsite)

Acadia Healthcare; Malden Highlands (MA); Presencial; USD 54 000 - 63 000; Tempo integral

Resumo da oferta

Acadia Healthcare and Tufts Medicine Behavioral Health Hospital in Malden, MA, seek a Utilization Specialist to monitor service utilization and optimize reimbursement for the new 144-bed hospital. You will coordinate with clinical staff and managed care organizations to ensure compliance and efficient patient care.

The role requires clinical experience or 2+ years in utilization management, with education in health-related fields.

Qualificações

• High school diploma or equivalent required.
• Preferred degree in Social Work, Behavioral or Mental Health, Nursing, or related field.
• Clinical experience required, or 2+ years in facility population; utilization management preferred.

Responsabilidades

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform staff of issues affecting stay.
• Gather and report utilization and discharge data for leadership.

Conhecimentos

Clinical experience

Utilization management

Communication with MCOs

Cross-functional liaison

Formação académica

High school diploma or equivalent

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

Descrição da oferta de emprego

Overview

Acadia Healthcare is a leading provider of behavioral healthcare services across the United States. Acadia operates a growing network of 250 plus behavioral healthcare facilities with approximately 11,100 beds in 39 states and Puerto Rico. With more than 23,000 employees serving approximately 75,000 patients daily, Acadia is the largest stand‑alone behavioral health company in the U.S.

Acadia Healthcare’s purpose is to Lead Care With Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation.

Tufts Medicine,a leading integrated academic health system in Massachusetts, and Acadia Healthcare, the largest standalone provider of behavioral health services in the U.S., have partnered to create the Tufts Medicine Behavioral Health Hospital, a state-of-the-art, 144-bed facility in Malden, Massachusetts. Slated to open in early 2026, this hospital is designed to address the growing need for high-quality behavioral health services in the region.

The Utilization Specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility.

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:

• Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

• 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.

Pay Range:$39.02 to $46.59/hr.

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 equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.