Utilization Specialist

ECU Health Behavioral Health Hospital•Greenville, NC

7d•Onsite

About The Position

Acadia Healthcare is a leading provider of behavioral healthcare services across the United States. Acadia operates a growing network of 250 plus behavioral healthcare facilities with approximately 11,100 beds in 39 states and Puerto Rico. With more than 23,000 employees serving approximately 75,000 patients daily, Acadia is the largest stand-alone behavioral health company in the U.S. Acadia Healthcare’s purpose is to Lead Care with Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation. We are looking for an ONSITE Utilization Specialist in Greenville, NC. Acadia Healthcare and ECU Health Behavioral Health Hospital have partnered to establish a state-of-the-art, two-story, 144-bed behavioral health hospital in Greenville, NC. This new facility will help meet the urgent need for accessible, high-quality psychiatric care in the region, expanding capacity to support patients with diverse mental health needs. Opened in December 2025, the hospital—located just under a mile from ECU Health Medical Center—offers a full range of inpatient and intensive outpatient services. Additionally, it will host GME and residency programs in psychiatry and internal medicine for ECU Health’s Brody School of Medicine, advancing medical education and training in behavioral health. Adults, seniors, children, and adolescents facing acute mental health challenges, including anxiety, depression, bipolar disorder, PTSD, and co-occurring disorders, will have access to specialized treatment and support at this center of excellence. What would you do in this role? Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Requirements

Required Education: High school diploma or equivalent.
Experience: Clinical experience is required, or two or more years' experience working with the facility's population.
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.

Nice To Haves

Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
Previous experience in utilization management is preferred
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.

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 extensions and inform 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.
Perform other functions and tasks as assigned.