Utilization Specialist

Overview Utilization Specialist Lakeland Behavioral Health System We’re Hiring a 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. Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities 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. Perform other functions and tasks as assigned. Qualifications 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. We 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. #J-18808-Ljbffr