Utilization Specialist

Act as liaison between managed care organizations and clinical staff to conduct utilization reviews, coordinate reimbursement communication, and monitor patient length of stay. Gather statistical and narrative information on utilization, non-certified days, discharges, and service quality for facility reporting. Perform quality reviews for medical necessity, facilitate peer review calls, and initiate formal appeals for denied admissions. Assist admissions with pre-certifications and provide ongoing staff training on documentation, stay criteria, and medical necessity updates. Monday-Friday, 40-hour day position at The Refuge in Ocala, Florida, offering $20–$24/hr.