On-Site Utilization Specialist

Acadia Healthcare • Brooksville, FL

2d • Onsite

About The Position

Sabal Palms Recovery Center is seeking a full-time Utilization Review Specialist for its addiction treatment facility in Brooksville, Florida. The facility provides residential treatment for adults aged 18 and older. The specialist proactively monitors utilization of services to optimize reimbursement and serves as a liaison between managed care organizations and facility clinical staff. This is an in-person, benefit-eligible position with a Monday–Friday, 40-hour workweek. Pay starts at $22 per hour and increases based on relevant experience.

Requirements

• High school diploma or equivalent.
• Clinical experience, or at least two years of experience working with the facility’s population.
• CPR and de-escalation and restraint certification; training is available upon hire and offered by the facility.
• Complete a Level 2 Background Screening through the Florida Care Provider Background Screening Clearinghouse.

Nice To Haves

• 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.
• First aid, if required by state or facility requirements.

Responsibilities

• Act as liaison between managed care organizations and facility professional clinical staff.
• Conduct reviews according to certification requirements for insurance plans and other managed care organizations, and coordinate communication about reimbursement requirements.
• Monitor patient length of stay and extensions, and inform clinical and medical staff about issues that may affect length of stay.
• Gather and develop statistical and narrative information on utilization, non-certified days and their causes, appeals, discharges, and quality of services, as required by facility leadership or the corporate office.
• Conduct quality reviews for medical necessity and services provided.
• Facilitate peer review calls between the facility and external organizations.
• Initiate and complete the formal appeal process for denied admissions or continued stays.
• Assist the admissions department with care pre-certifications.
• Provide ongoing staff support and training on documentation and charting requirements, continued-stay criteria, and medical-necessity updates.
• Perform other functions and tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED