Utilization Specialist: Reimbursement & Care Coordination

Acadia Healthcare; Ada (OK); On-site; USD 42,000 - 68,000; Full time

Job summary

Acadia Healthcare in Ada, OK is seeking a Utilization Review professional to proactively monitor service utilization for reimbursement optimization. The role functions as a liaison between managed care organizations and facility staff, conducts plan reviews, and coordinates communication on reimbursement requirements.

The position emphasizes monitoring length of stay, gathering data for reporting, and performing medical necessity reviews.

Qualifications

• Clinical experience is required, or two or more years' experience with the facility population.
• Utilization management experience preferred.
• State-appropriate licensure or professional certification is recommended.

Responsibilities

• Act as liaison between managed care organizations and the facility clinical staff.
• Conduct reviews, per certification requirements, of insurance plans and coordinate communication on reimbursement needs.
• Monitor patient length of stay and inform staff of issues impacting stay.
• Gather data to report on utilization, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls with external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stay.
• Assist admissions with pre-certifications of care.
• Provide ongoing staff training on documentation and medical necessity updates.

Skills

Clinical experience

Utilization management

Documentation

Communication

Interdisciplinary coordination

Education

High school diploma or equivalent

Associate's degree in Health or related field

Bachelor's or Master’s in Social Work or Nursing

Job description

Acadia Healthcare in Ada, OK is seeking a Utilization Review professional to proactively monitor service utilization for reimbursement optimization. The role functions as a liaison between managed care organizations and facility staff, conducts plan reviews, and coordinates communication on reimbursement requirements.

The position emphasizes monitoring length of stay, gathering data for reporting, and performing medical necessity reviews.