Utilization Specialist: Reimbursement & Care Coordination

Acadia Healthcare; Malden Highlands (MA); On-site; USD 54,000 - 63,000; Full time

Job summary

Acadia Healthcare and Tufts Medicine Behavioral Health Hospital in Malden, MA, seek a Utilization Specialist to monitor service utilization and optimize reimbursement for the new 144-bed hospital. You will coordinate with clinical staff and managed care organizations to ensure compliance and efficient patient care.

The role requires clinical experience or 2+ years in utilization management, with education in health-related fields.

Qualifications

• High school diploma or equivalent required.
• Preferred degree in Social Work, Behavioral or Mental Health, Nursing, or related field.
• Clinical experience required, or 2+ years in facility population; utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility staff.
• Conduct reviews of insurance plans and coordinate communication on reimbursement requirements.
• Monitor patient length of stay and inform staff of issues affecting stay.
• Gather and report utilization and discharge data for leadership.

Skills

Clinical experience

Utilization management

Communication with MCOs

Cross-functional liaison

Education

High school diploma or equivalent

Bachelor’s/Associate/Master’s in Social Work or related health field

Job description

Acadia Healthcare and Tufts Medicine Behavioral Health Hospital in Malden, MA, seek a Utilization Specialist to monitor service utilization and optimize reimbursement for the new 144-bed hospital. You will coordinate with clinical staff and managed care organizations to ensure compliance and efficient patient care.

The role requires clinical experience or 2+ years in utilization management, with education in health-related fields.