The Camp Recovery Center·Scotts Valley, California
The Utilization Specialist acts as a liaison between managed care organizations and clinical staff, conducting reviews for reimbursement requirements and monitoring patient length of stay. Key duties include gathering utilization statistics, conducting quality reviews for medical necessity, facilitating peer review calls, and managing the formal appeal process for denied stays.
Overview Utilization Specialist Opportunity (8hours shifts) at The Camp Recovery Center – Scotts Valley, CA Pay Range$25.00 - $27.00: 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. Medi-Cal Experience and Understanding Preferred
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. OTHER FUNCTIONS: Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 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 UM Experience preferred Medi-Cal experience and understanding preferred LICENSES/DESIGNATIONS/CERTIFICATIONS: 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. 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. COMPENSATION: Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below. Role Location: CALIFORNIA Calculated Hourly Range for role Utilization Specialist State – California: $25.00 - $27.00
For Full Time Staff only The Camp Recovery Center provides a comprehensive package of benefits for our Full Time Utilization Specialist.. Current benefits include: 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 that is second to none in the industry. AVAILABLE SHIFTS AND HOURS: This is a Full-Time EMT position Monday - Friday . Shifts are 8 – hours, and are overtime eligible ADDITIONAL REGULATORY REQUIREMENTS: As Needed While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (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.
A high school diploma or equivalent is required, though an Associate's, Bachelor's, or Master's degree in a related health field is preferred. Candidates must have clinical experience or two or more years working with the facility's population, and CPR/de-escalation/restraint certification is mandatory.
Market context
In California, behavioral-health roles tied to substance use disorder counseling and case management are typically supported by ongoing community and treatment-program demand. These positions are competitive because employers often look for a high school diploma, at least 2 years of SUD counseling or case management experience, and current Registered or Certified Drug and Alcohol Counselor status. Review the AI-summarized requirements and benefits here to quickly compare fit and note that professional development and paid continuing education are listed as benefits.
Behavioral Health Associate - 24 Hours
Peer Support Specialist
