Utilization Specialist
Acadia Healthcare
Overview PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities ESSENTIAL FUNCTIONS:
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
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. HVBHL #LI-HPBH
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.
- 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
- Required Licensure: LPN or RN 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.
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
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. HVBHL #LI-HPBH
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Utilization Specialist in Haverhill, MA vacancy
- Haverhill Pavilion Behavioral Health is seeking a qualified professional to monitor service utilization and support reimbursement processes. The role acts as liaison between managed care organizations and the facility staff, conducts plan reviews, and coordinates communications...Suggested
- ...Federal, State, Provincial and Company safety and health regulations, and where applicable, proper personal protective equipment is utilized. Solid understanding of Quality/ Incoming inspection and will be responsible for the tasks associated with this role. May be...SuggestedContract workFlexible hours
NCSL International
Plaistow, NH5 days ago - The Trenchless Technology Specialist / Design Consultant will support planning, design, and construction of trenchless conveyance infrastructure... ...progressive experience delivering trenchless and underground utility infrastructure projects (planning through construction). Hands...SuggestedFull timeTemporary workFor contractorsRemote work
$86.8k - $165.2k
...Raytheon Missiles & Defense Andover has an opening for a Principal Specialist Materials Planning in our Materials Planning and Sales,... ...Requirements Planning (MRP) systems in a manufacturing environment and utilizes data-driven decision making to enable effective planning and...SuggestedContract workTemporary workWork experience placementWork at officeRemote workFlexible hours$52.62k
Overview The ACCS Lead Peer Specialist promotes the engagement, hope and the full integration and functioning of Persons Served (PS) needed to live successfully in the community. Welcomes, orients and engages PS into service, collaborates with LPHA to determine needed...SuggestedWork at officeRelocation package$52.62k
Vinfen seeks an ACCS Lead Peer Specialist in Haverhill, MA, to promote engagement and integration of Persons Served in the community. This role includes supervising a team of Peer Specialists, providing support, and facilitating peer support groups. Candidates must have...$82k - $164k
...Operations has an opportunity for a Production Control Scheduling Specialist in the Andover, MA, Cabinet Integration Center. The successful... ...Planning (MRP) systems in a manufacturing environment and utilizes data-driven decision making to enable effective material and workforce...Temporary workWork experience placementFor subcontractorFlexible hoursRaytheon
Andover, MA1 day ago- ...Card Manufacturing (CCM) Factory as the Continuous Improvement Specialist. The Specialist is responsible for leading projects which... ...test engineering, quality engineering, and operations, while utilizing CORE principles. The Specialist will report directly to the New...
Raytheon
Andover, MA13 hours ago - ...Job Description Position Purpose: The Asset Protection Specialist is primarily responsible for preventing financial loss caused... ...program compliance in their assigned store/multiple stores. They utilize tools to minimize loss to the Company, including but not...Local area
Home Depot
Salem, NH2 days ago - ...Menu Specialist Whittier Rehabilitation Hospital is looking for a dependable and detail-oriented Menu Specialist to support our Nutrition Services team on weekends. This isn't your average food service job—you'll play a key part in helping patients get the right meals...Temporary workPart timeFlexible hoursWeekend workWeekday work
Whittier Health Network
Haverhill, MA4 days ago - ...The Delivery Specialist will maintain and operate store vehicles to deliver parts and/or products to professional customers in a safe and efficient manner. This position will also collect money on C.O.D. deliveries and pick up customer returns. Bilingual candidates...Local areaImmediate startFlexible hours
O'Reilly Auto Parts
Plaistow, NH5 days ago - Waystone Health & Human Services in Haverhill, MA is seeking a Day Habilitation Program Supervisor to lead daily operations, supervise staff, and ensure safe, compliant services for individuals with ID/DD. This role requires coordinating program activities and maintaining...
ADDP
Haverhill, MA2 days ago $15 - $20 per hour
...Parts Specialist Compensation Pay Range: $15.00 - $20.00 The actual hourly rate will equal or exceed the required minimum wage applicable to the job location. Additional compensation includes annual, quarterly performance, or premiums may be paid in amounts ranging...Hourly payMinimum wageLocal areaFlexible hoursO'Reilly Auto Parts
Haverhill, MA5 days ago$22 - $23 per hour
Häns Kissle, a Massachusetts-based food manufacturer, seeks a detail-oriented 3rd Shift Sanitation Worker to ensure the cleanliness of equipment and production areas in our 112,000 square foot facility, following GMP/SQF standards. You will safely use cleaning chemicals...Hourly payMonday to FridayNight shiftHäns Kissle
Haverhill, MA5 days ago$15 - $20 per hour
...schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met. The Delivery Specialist will maintain and operate store vehicles to deliver parts and/or products to professional customers in a safe and efficient manner...Hourly payMinimum wageLocal areaImmediate startFlexible hoursO'Reilly Auto Parts
Haverhill, MA4 days ago$15k
...constraints, interrupt-driven design, memory-mapped I/O, and performance optimization in resource-constrained environments. Experience utilizing DevOps practices, Jenkins, and continuous integration tools. Preferred Additional Skills: Active Top Secret or TS/SCI clearance is...Local areaRelocation packageFlexible hoursL3Harris Technologies
Groveland, MA2 days ago- Milton Hershey School, a cost-free pre-K through 12th grade residential school, is seeking a Youth Development Specialist in the Education, Training & E-Learning department. This role supports students’ academic, social, and emotional growth through mentoring, small-group...Full time
Milton Hershey School
Haverhill, MA28 days ago $1,000 per month
...Occupancy Specialist Bradford, MA (Presidential) Administrative Full Time 653022 Established in 1981, Maloney Properties LLC is a successful real estate firm. Our services include property management, real estate development, hospitality management, sales/marketing...Full timeInterim roleWork at officeRemote workMonday to FridayFlexible hours$50 - $54 per hour
...Accounts Payable Specialist Creative Financial Staffing is partnered with a distribution company located in Haverhill, MA to identify an Accounts Payable Specialist. This is a new position due to growth. Why Work Here? They are a rapidly growing high-tech company...Summer work$50 - $54 per hour
...Accounts Payable Specialist Creative Financial Staffing is partnered with a distribution company located in Haverhill, MA to identify an Accounts Payable Specialist. This is a new position due to growth and involves training in accounts payable. Why Work Here?...Summer work- Whittier Rehabilitation Hospital in Bradford, MA is seeking a dependable Menu Specialist to support Nutrition Services on weekends. This part-time role focuses on tailoring meals to medical and cultural needs, ensuring safety and accuracy in menu execution. You’ll work...Part timeShift workWeekend work
- A leading home improvement retailer is seeking an Asset Protection Specialist to prevent financial loss due to theft and fraud. Your responsibilities will include documenting incidents, preparing detailed reports, and interacting with law enforcement. The ideal candidate...
- Thom Child & Family Services in West Newbury, MA is seeking a Bilingual Developmental Specialist/Early Childhood Educator to provide home and community-based early intervention services to infants and toddlers born to three years old and their families. You will collaborate...Work from home
- Now Hiring: Inclusion Specialist (Full-Time) YMCA of the North Shore - Haverhill YMCA Supporting After‑School Programs & Summer Camp Do you believe every child deserves the opportunity to feel included, supported, and successful? Are you passionate about helping children...Full timeSummer workLocal areaImmediate start
- ...up CNC Vertical and Horizontal Mills (4-axis with palletizing) as well as CNC Turning and Manual Turning. Throughout the run, you utilize measuring devices to confirm part characteristics meet conformance requirements, documenting results on inspection records and logging...Day shiftAfternoon shift
$48.52k
Vinfen is seeking a Family Connector in Haverhill, MA, to promote community integration for persons served through outreach and support services. This role involves providing psycho-education to families, effectively engaging them in treatment plans, and collaborating with...- (IMMEDIATE HIRE) Pet Nutrition Specialist The Associate is responsible for completing in-store pet food and non-food customer interactions with shoppers and their pets. The Associate acquires and maintains a high level of knowledge of products represented. The Associate...Immediate start
$22.75 per hour
...Certified Safelite Repair Specialist I As a certified Safelite Repair Specialist I, you will utilize our industry-leading technology to complete vehicle glass repairs. You will champion the Safelite Spirit with your can-do attitude, caring heart, and service mindset...Weekly payLocal area$54k - $60k
Bilingual-Spanish or Portuguese Developmental Specialist Thom Child And Family Services West Newbury, Massachusetts, United States About this position This position offers a salary range of $54,000 to $60,000. Actual pay will be based on relevant skills, qualifications...Daily paidTemporary workWork experience placementWork from homeFlexible hours$86.8k - $165.2k
...world. This position serves as a Continuous Improvement (CI) Specialist supporting semiconductor manufacturing operations. Reporting... ...factory throughput, improve process flow, enhance equipment utilization, and enable scalable growth. This role partners closely with...Contract workTemporary workWork experience placementWork at officeRemote workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Specialist. Be the first to apply!
Related searches
- treasury specialist Haverhill, MA
- helpdesk specialist Haverhill, MA
- international relations specialist Haverhill, MA
- mental health specialist Haverhill, MA
- loss prevention specialist Haverhill, MA
- writing specialist Haverhill, MA
- executive protection specialist Haverhill, MA
- fabrication specialist Haverhill, MA
- lighting specialist Haverhill, MA
- credit specialist Haverhill, MA