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

Medical, dental, and vision insurance

401(k) plan with company match

Equity/stock-based incentive awards

Generous paid time off

Job summary

Coastal Pines Behavioral Health, a new 144-bed behavioral health hospital near Jacksonville, seeks a full-time Utilization Specialist to monitor utilization of services and optimize reimbursement for the facility. The role involves liaising with managed care organizations, reviewing plans for medical necessity, and supporting admissions with pre-certifications.

Ideal candidates have clinical experience and may possess degrees in social work, nursing, or related health fields.

Qualifications

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

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 of issues affecting stay.
• Gather data and report on utilization, non-certified days, discharges and quality of services.
• Conduct reviews for medical necessity and services provided.
• Facilitate peer review calls with external organizations.
• Initiate and complete the appeal process for denied admissions or continued stay.
• Assist the admissions department with pre-certifications of care.
• Provide ongoing training on documentation, stay criteria, and medical necessity updates.
• Perform other duties as assigned.

Skills

Clinical experience

Utilization management

MCO liaison

Education

High school diploma or equivalent

Associate's/Bachelor's/Master's in Social Work, Behavioral/Mental Health, Nursing, or related field

Job description

Coastal Pines Behavioral Health, a new 144-bed behavioral health hospital near Jacksonville, seeks a full-time Utilization Specialist to monitor utilization of services and optimize reimbursement for the facility. The role involves liaising with managed care organizations, reviewing plans for medical necessity, and supporting admissions with pre-certifications.

Ideal candidates have clinical experience and may possess degrees in social work, nursing, or related health fields.