Utilization Management Specialist

Utilization Specialist – New Behavioral Health Hospital near Jacksonville, FL - Opened August 2026We are seeking a full-time Utilization Specialist to proactively monitor utilization of services for patients to optimize reimbursement for the facility.Coastal Pines is a modern, purpose-built facility and a cornerstone of behavioral health care in Northeast Florida, designed to meet the growing demand for high-quality psychiatric services in the region. The 144-bed behavioral health hospital, located in St. Johns, will offer a full continuum of services including inpatient psychiatric care, Partial Hospitalization Program (PHP), Intensive Outpatient Program (IOP), and Electroconvulsive Therapy (ECT).What We Offer:Our leaders are equipped with the tools, support, and benefits they need to thrive:Competitive compensation package including performance-based incentivesComprehensive medical, dental, and vision insurance401(k) plan with company match through Acadia HealthcareEquity/stock-based incentive awards for long-term financial growthGenerous paid time off including vacation, holidays, and sick daysIf you're ready to lead with purpose and drive lasting impact in the behavioral health space, we invite you to consider joining us at Coastal Pines Behavioral Health.Essential Functions: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.Other Functions:Perform other functions and tasks as assigned.Education/Experience/Skill Requirements:Required Education: High school diploma or equivalent.Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred.Licenses/Designations/Certifications: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.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.Additional Regulatory Requirements:While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.