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Utilization Specialist

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Acadia Healthcare

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Location:
United States , Scotts Valley

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Category:
Nursing

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Contract Type:
Employment contract

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Salary:

25.00 - 27.00 USD / Hour
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Job Description:

We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley! This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.

Job Responsibility:

  • 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

Requirements:

  • High school diploma or equivalent
  • Clinical experience is required, or two or more years' experience working with the facility's population
  • CPR and de-escalation and restraint certification required
  • First aid may be required based on state or facility requirements

Nice to have:

  • 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
  • UM Experience
  • Medi-Cal experience and understanding
  • 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
What we offer:
  • Competitive hourly rate
  • Shift differential for overnight shifts
  • Medical, dental, and vision insurance
  • Acadia Healthcare 401(k) plan
  • Excellent training program
  • Complimentary AOD Education to certify as a Substance Use Disorder Counselor
  • Professional growth opportunity

Additional Information:

Job Posted:
May 14, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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