{"schemaVersion":"jobsearcher.job.v1","id":"e592b0352dbaf1ab7d4e7e88","url":"https://jobsearcher.com/jobs/e592b0352dbaf1ab7d4e7e88","canonicalUrl":"https://jobsearcher.com/jobs/e592b0352dbaf1ab7d4e7e88","title":"Utilization Specialist","description":"Purpose Statement\nProactively monitor utilization of services for patients to optimize reimbursement for the facility.\n\nEssential Functions\n\nAct as liaison between managed care organizations and the facility professional clinical staff.\n\nConduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.\n\nMonitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.\n\nGather 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.\n\nConduct quality reviews for medical necessity and services provided.\n\nFacilitate peer review calls between facility and external organizations.\n\nInitiate and complete the formal appeal process for denied admissions or continued stay.\n\nAssist the admissions department with pre-certifications of care.\n\nProvide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.\n\nOther Functions\n\nPerform other functions and tasks as assigned.\n\nEducation / Experience / Skill Requirements\n\nRequired Education: High school diploma or equivalent.\n\nPreferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.\n\nExperience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.\n\nLicenses / Designations / Certifications\n\nPreferred 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.\n\nCPR and de-escalation and restraint certification required (training available upon hire and offered by facility).\n\nFirst aid may be required based on state or facility requirements.\n\nWe 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.\n\n#J-18808-Ljbffr","company":"Acadia","rawCompany":"acadia","city":"Magee","state":"MS","isRemote":false,"isActive":false,"createdAt":"2026-07-16T03:29:23.785Z","occupations":[{"code":"21-1022.00","title":"Healthcare Social Workers","slug":"healthcare-social-workers"},{"code":"21-1023.00","title":"Mental Health and Substance Abuse Social Workers","slug":"mental-health-and-substance-abuse-social-workers"},{"code":"11-9111.00","title":"Medical and Health Services Managers","slug":"medical-and-health-services-managers"}],"industries":[{"code":"622110","title":"General Medical and Surgical Hospitals","slug":"general-medical-and-surgical-hospitals"},{"code":"623110","title":"Nursing Care Facilities (Skilled Nursing Facilities)","slug":"nursing-care-facilities-skilled-nursing-facilities"},{"code":"622210","title":"Psychiatric and Substance Abuse Hospitals","slug":"psychiatric-and-substance-abuse-hospitals"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Utilization Specialist","description":"Purpose Statement\nProactively monitor utilization of services for patients to optimize reimbursement for the facility.\n\nEssential Functions\n\nAct as liaison between managed care organizations and the facility professional clinical staff.\n\nConduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.\n\nMonitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.\n\nGather 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.\n\nConduct quality reviews for medical necessity and services provided.\n\nFacilitate peer review calls between facility and external organizations.\n\nInitiate and complete the formal appeal process for denied admissions or continued stay.\n\nAssist the admissions department with pre-certifications of care.\n\nProvide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.\n\nOther Functions\n\nPerform other functions and tasks as assigned.\n\nEducation / Experience / Skill Requirements\n\nRequired Education: High school diploma or equivalent.\n\nPreferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.\n\nExperience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.\n\nLicenses / Designations / Certifications\n\nPreferred 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.\n\nCPR and de-escalation and restraint certification required (training available upon hire and offered by facility).\n\nFirst aid may be required based on state or facility requirements.\n\nWe 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.\n\n#J-18808-Ljbffr","datePosted":"2026-07-16T03:29:23.785Z","dateModified":"2026-07-16T03:29:23.785Z","hiringOrganization":{"@type":"Organization","name":"Acadia","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Magee","addressRegion":"MS","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"e592b0352dbaf1ab7d4e7e88"},"url":"https://jobsearcher.com/jobs/e592b0352dbaf1ab7d4e7e88"}}