Utilization Specialist

Utilization Specialist

Lakeland Behavioral Health System is looking for a Utilization Specialist to help support patient care and keep our clinical teams moving.

Monday - Friday

8am-4pm or flexible

Hourly: $18.00 - $22.00

What You'll Do

• Coordinate with managed care partners
• Review insurance requirements
• Track length of stay
• Compile key utilization data
• Conduct medical necessity reviews
• Lead appeals & support pre-certs
• Train staff on documentation standards
• Make an impact. Support great care. Grow your career.

Lakeland has spent more than 30 years creating a warm, supportive place where people can find real hope and healing. Rooted in clinical excellence and evidence-based care, our team is dedicated to helping every individual feel seen, supported, and truly cared for. With a wide range of therapeutic opportunities, we empower each person to move toward lasting wellness in a compassionate environment that feels like a community. Apply today!

Purpose Statement

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

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).