Utilization Specialist: Optimize Reimbursement & Care

Acadia Healthcare; Henderson (NV); On-site; USD 60,000 - 85,000; Full time

Job summary

Acadia Healthcare is seeking a healthcare professional to monitor utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations, reviewing plans for eligibility, and coordinating communications on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering utilization data, and conducting quality reviews for medical necessity.

Qualifications

• Clinical experience is required, or two or more years working with the facility's population.
• Preferred licensure or certification within the state where the facility provides services.
• Comfort with insurance and reimbursement workflows.

Responsibilities

• Act as liaison between managed care organizations and the facility staff.
• Review insurance plans for certification requirements and coordinate reimbursement communication.
• Monitor patient length of stay and inform staff on issues affecting stay length.
• Gather data on utilization, discharges, and service quality for leadership.
• Conduct quality reviews for medical necessity and services provided.
• Coordinate and conduct appeals for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide training on documentation, stay criteria, and medical necessity updates.

Skills

Clinical experience

Education

Associates/Bachelors/Masters in Health

Job description

Acadia Healthcare is seeking a healthcare professional to monitor utilization and optimize reimbursement for the facility. The role involves liaising with managed care organizations, reviewing plans for eligibility, and coordinating communications on reimbursement requirements.

Responsibilities include monitoring length of stay, gathering utilization data, and conducting quality reviews for medical necessity.