Utilization Specialist- Onsite

Coastal Pines Behavioral Health; Saint Augustine (FL); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Competitive compensation

Medical insurance

401(k) plan with company match

Equity/stock-based incentives

Paid time off

Job summary

Coastal Pines Behavioral Health seeks a full-time Utilization Specialist to proactively monitor service utilization and optimize reimbursement for a 144-bed behavioral health hospital near Jacksonville, FL. The role involves liasing with managed care organizations, reviewing plans, and guiding clinical staff on reimbursement requirements.

The candidate will analyze length of stay, gather data for reports, and conduct medical necessity reviews.

Qualifications

• Clinical experience is required or two years' experience working with the facility's population
• Experience in utilization management is preferred
• Preferred education in Social Work / Behavioral or Mental Health / Nursing or related health field

Responsibilities

• Act as liaison between managed care organizations and the facility professional clinical staff
• Conduct reviews of insurance plans or other managed care organizations and coordinate the flow of communication concerning reimbursement requirements
• Monitor patient length of stay and extensions and inform clinical staff on issues that may impact length of stay
• Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges and quality of services
• 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
• Perform other functions and tasks as assigned

Skills

Utilization management

Education

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

High school diploma or equivalent

Job description

Utilization Specialist – New Behavioral Health Hospital near Jacksonville, FL - Opened August 2026

We are seeking a full-time Utilization Specialist to p roactively monitor utilization of services for patients to optimize reimbursement for the facility.

Coastal Pines is a modern, purpose-built facility and a cornerstone of behavioral health care in Northeast Florida, designed to meet the growing demand for high-quality psychiatric services in the region. The 144-bed behavioral health hospital, located in St. Johns, will offer a full continuum of services including inpatient psychiatric care, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Electroconvulsive Therapy (ECT).

What We Offer

• Competitive compensation package including performance-based incentives
• Comprehensive medical, dental, and vision insurance
• 401(k) plan with company match through Acadia Healthcare
• Equity/stock-based incentive awards for long-term financial growth
• Generous paid time off including vacation, holidays, and sick days

If you're ready to lead with purpose and drive lasting impact in the behavioral health space, we invite you to consider joining us at Coastal Pines Behavioral Health.

Responsibilities

• 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 extension s and i nform 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.

Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Required Education: High school diploma or equivalent.
• Preferred Education : Associate's, Bachelor's, or M aster’s degree in S ocial W ork , B ehavioral or M ental H ealth, N ursing, 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

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.

Additional Regulatory Requirements

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 par ticular 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.