Utilization Specialist: Behavioral Health & SUD – Full-Time

Acadia Healthcare; Scotts Valley (CA); On-site; USD 34,440 - 37,195; Full time

Benefits offered by this job

Competitive rate

Shift differential

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Training program

AOD education

Career growth

Job summary

The Camp Recovery Center in Scotts Valley, CA is hiring a compassionate Utilization Specialist to support adults with co-occurring disorders in an inpatient/outpatient setting. The role focuses on clinical coordination, medical necessity reviews, and communication with managed care organizations to ensure appropriate, timely care.

This full-time 8-hour shift position offers a pay range of $25.00–$27.00 per hour, with competitive benefits, a strong training program, and opportunities for

Qualifications

• High school diploma or equivalent required.
• Clinical experience with the population required; utilization management experience preferred.
• Medi-Cal experience preferred.
• UM experience preferred.
• Licensure in state preferred where applicable.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Review insurance plans and coordinate reimbursement communications.
• Monitor patient length of stay and inform staff of related issues.
• Collect data to report utilization, discharges and quality of services.
• Conduct quality reviews for medical necessity.
• Facilitate peer review calls with external organizations.
• Initiate and complete the formal appeal process for denied admissions.
• Assist admissions with pre-certifications of care.
• Provide staff training on documentation and criteria.

Skills

Clinical experience

Medi-Cal experience

Utilization management

CPR certification

Education

High school diploma or equivalent

Associate/Bachelor/Master in related health field

Job description

The Camp Recovery Center in Scotts Valley, CA is hiring a compassionate Utilization Specialist to support adults with co-occurring disorders in an inpatient/outpatient setting. The role focuses on clinical coordination, medical necessity reviews, and communication with managed care organizations to ensure appropriate, timely care.

This full-time 8-hour shift position offers a pay range of $25.00–$27.00 per hour, with competitive benefits, a strong training program, and opportunities for