Utilization Specialist (100% onsite)

Acadia Healthcare; Saint Augustine (FL); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive compensation package with绩

Comprehensive medical, dental, vision

401(k) with company match

Equity/stock-based incentives

Generous paid time off

Job summary

Coastal Pines Behavioral Health, opened August 2026 near Jacksonville, FL, seeks a full-time Utilization Specialist to monitor utilization and optimize reimbursement for the new 144-bed behavioral health hospital.

You will act as liaison between managed care organizations and clinical staff, review plans for certification, and report utilization metrics while supporting admissions with pre-certifications and ongoing staff training.

Qualifications

• High school diploma or equivalent is required.
• Clinical experience or two+ years in facility population; utilization management preferred.
• Licensure or certification in relevant clinical field preferred (LPN, RN, LMSW, LCSW, etc.).

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Review insurance plans for certification requirements and coordinate reimbursement communications.
• Monitor length of stay and inform staff on issues affecting stay duration.
• Gather data to report utilization, non-certified days, discharges, and service quality.
• Perform quality reviews for medical necessity and services provided.
• Support admissions with pre-certifications of care and staff training on documentation.

Skills

Clinical experience

Utilization management

Interdepartmental coordination

Communication with MCOs

Education

High school diploma or equivalent

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

Job description

Overview

Utilization Specialist – New Behavioral Health Hospital near Jacksonville, FL - Opened August 2026

We are seeking a full-time Utilization Specialist to proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Coastal Pines is a modern, purpose-built facility and a cornerstone of behavioral health care in Northeast Florida, designed to meet the growing demand for high-quality psychiatric services in the region. The 144-bed behavioral health hospital, located in St. Johns, will offer a full continuum of services including inpatient psychiatric care, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Electroconvulsive Therapy (ECT).

What We Offer:

Our leaders are equipped with the tools, support, and benefits they need to thrive:

• Competitive compensation packageincluding performance-based incentives
• Comprehensive medical, dental, and vision insurance
• 401(k) plan with company match through Acadia Healthcare
• Equity/stock-based incentive awardsfor long-term financial growth
• Generous paid time offincluding vacation, holidays, and sick days

If you're ready to lead with purpose and drive lasting impact in the behavioral health space, we invite you to consider joining us at Coastal Pines Behavioral Health.

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.
• 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.

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

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.