Utilization Specialist — Behavioral Health Reimbursement

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

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.