Utilization Specialist: Behavioral Health Admissions Liaison

Acadia Healthcare; Malden Highlands (MA); Sur place; USD 54 000 - 65 000; Plein temps

Résumé du poste

Acadia Healthcare, in partnership with Tufts Medicine, is opening a 144-bed behavioral health hospital in Malden, MA. The Utilization Specialist role focuses on monitoring service utilization, improving reimbursement processes, and supporting staff with documentation and criteria.

The position requires clinical experience or 2+ years in the target population, with preferred qualifications in social work or related health fields and CPR/de‑escalation certification.

Qualifications

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

Responsabilités

• Act as liaison between managed care organizations and the facility professional clinical staff.
• Review insurance plans for certification requirements and coordinate reimbursement communication.
• Monitor patient length of stay and inform staff on issues affecting stay.
• Gather statistics and narrative information on utilization, discharges and services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between the facility and 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 stay criteria.
• Perform other duties as assigned.

Connaissances

Clinical experience

Utilization management

Pre-certifications

Formation

High school diploma or equivalent

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

Description du poste

Acadia Healthcare, in partnership with Tufts Medicine, is opening a 144-bed behavioral health hospital in Malden, MA. The Utilization Specialist role focuses on monitoring service utilization, improving reimbursement processes, and supporting staff with documentation and criteria.

The position requires clinical experience or 2+ years in the target population, with preferred qualifications in social work or related health fields and CPR/de‑escalation certification.