Utilization Specialist

Monitor utilization of services for patients to optimize reimbursement by acting as a liaison between managed care organizations and clinical staff. Conduct reviews of insurance plans, coordinate communication on reimbursement requirements, and monitor patient length of stay to inform clinical decisions. Gather statistical and narrative information on utilization, non-certified days, discharges, and quality of services for facility leadership. Initiate formal appeals for denied admissions, assist with pre-certifications, and facilitate peer review calls. Provide ongoing support and training for staff on documentation, charting requirements, and medical necessity updates.