Utilization Specialist - 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

Utilization Specialist Opportunity (8 hours shifts) at The Camp Recovery Center – Scotts Valley, CA

Pay Range$25.00 - $27.00:

We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley! This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.

Essential Functions

Medi-Cal Experience and Understanding Preferred

• 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.

Other Functions

• Perform other functions and tasks as assigned.

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.
• UM Experience preferred.
• Medi-Cal experience and understanding 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.

Compensation

Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

Role Location: CALIFORNIA

Calculated Hourly Range for role Utilization Specialist

State – California: $25.00 - $27.00

BENEFITS: For Full Time Staff only

• Competitive hourly rate
• Shift differential for overnight shifts
• Medical, dental, and vision insurance
• Acadia Healthcare 401(k) plan
• Excellent training program
• Complimentary AOD Education to certify as a Substance Use Disorder Counselor
• Professional growth opportunity that is second to none in the industry.

Available Shifts And Hours

This is a Full-Time EMT position Monday - Friday. Shifts are 8 – hours, and are overtime eligible.

Additional Regulatory Requirements

As Needed

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 (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

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.