Utilization Management

Acadia Healthcare is hiring a fulltime Clinical Utilization Review Manager for our residential and outpatient programs of three Eating Disorder Primary Facilities. This position is fully remote. Apply your clinical skills to telephonically provide and facilitate utilization review continued stay reviews and utilization management of all patient cases based on clinical experience and recognized guidelines.

The Utilization Review Manager plays a vital role in monitoring utilization of services to ensure appropriate care and optimal reimbursement for patients receiving treatment for eating disorders. This position supports Acadia Healthcareby overseeing utilization review for patients at three residential and outpatient treatment facilities all specializing in eating disorder treatment. The role ensures services are clinically appropriate and financially supported through accurate and timely insurance authorization processes.

ESSENTIAL FUNCTIONS:

• Serve as the primary liaison with insurance companies to secure and maintain authorizations for patient admissions and continued stays.

• Review clinical documentation to assess medical necessity and advocate for appropriate levels of care.

• Evaluate the utilization review program across the three assigned facilities for compliance with regulatory standards and internal policies.

• Manage denied claims by comparing documentation against payer criteria to determine adequacy and recommend improvements.

• Supervise the UR team including hiring training coaching and performance management.

ADDITIONAL RESPONSIBILITIES:

• Maintain timely accurate documentation in all relevant systems.

• Communicate proactively and professionally with supervisors and team members ensuring consistent responsiveness and availability in a remote setting.

• Attend scheduled checkins and respond promptly to leadership outreach.

• Perform other duties as assigned.

QUALIFICATIONS:

Education/Experience/Skills:

• Associates degree required. Bachelors or Masters degree in social work behavioral or mental health nursing or a related health field preferred.

• Minimum of four (4) years of clinical experience with relevant populations and direct experience in utilization management required.

• At least one (1) year of supervisory experience is required.

• Experience working remotely with high accountability time management and independence preferred.

Licenses/Certifications:

• Current LPN or RN license or equivalent clinical license/certification as required by the state.

This is a fully remoteposition supporting Acadia Healthcares three residential and outpatient treatment facilitiesfor individuals with primary diagnoses of eating disorders. The ideal candidate will demonstrate strong organizational skills maintain clear and timely communication and ensure accountability in a virtual environment.

Compensation for roles at Montecatini varies depending on a wide array of factors including but not limited to the specific location role skill set and level of required by local law Montecatini provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.

Role Location: Remote

Calculated Hourly Range for role

California: $35$37per hour