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Utilization Specialist Jobs (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the facility ...

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

Harboroaks

Utilization Specialist

Wilmington, NC · On-site

$60 - $80/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

New

Acadia Healthcare

Utilization Specialist

Moosic, PA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the facility ...

Acadia Healthcare

Utilization Specialist

Moosic, PA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

Acadia Healthcare

Utilization Specialist

Wilmington, NC · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...

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Utilization Specialist information

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$15

$31

$53

How much do utilization specialist jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization specialist in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.

What skills and qualifications does a utilization specialist need?

To thrive as a Utilization Specialist, you need a background in healthcare or social work, strong analytical abilities, and knowledge of insurance or case management processes, often supported by a relevant degree or certification. Familiarity with utilization review software, electronic health records (EHRs), and medical coding systems like ICD-10 or CPT is typically required. Excellent communication, attention to detail, and problem-solving skills help in coordinating care and advocating for patients. These competencies are crucial for ensuring appropriate resource use, compliance with regulations, and positive outcomes for both patients and healthcare organizations.

How does a utilization specialist collaborate with clinical teams to optimize patient care and resource management?

Utilization Specialists work closely with physicians, nurses, and case managers to review patient cases, ensure appropriate use of healthcare services, and facilitate timely care transitions. They often participate in interdisciplinary meetings, communicate medical necessity to insurance providers, and help develop care plans that balance quality outcomes with cost-effectiveness. This collaboration requires strong communication skills and a thorough understanding of clinical guidelines, making the role both challenging and rewarding for those who enjoy teamwork and problem-solving in a healthcare setting.

What is the difference between Utilization Specialist vs Utilization Coordinator?

AspectUtilization SpecialistUtilization Coordinator
CertificationsOften requires healthcare or insurance-related certificationsSimilar certifications, sometimes with additional administrative credentials
Work EnvironmentHealthcare facilities, insurance companies, or managed care organizationsHealthcare settings, insurance providers, or case management teams
Job FocusAnalyzing and optimizing resource utilization, ensuring complianceCoordinating utilization activities, scheduling, and communication

Utilization Specialists primarily analyze and optimize resource use within healthcare or insurance settings, focusing on compliance and efficiency. Utilization Coordinators handle the coordination and communication aspects of utilization management, often supporting the Specialist's work. Both roles require similar certifications and work environments, but their core responsibilities differ in focus and daily tasks.

What is a utilization specialist?

A utilization specialist is a professional who manages and analyzes the use of resources, such as staff or equipment, to ensure efficiency and cost-effectiveness within an organization. They often work in healthcare, staffing, or project management environments, using data and software tools to optimize resource allocation.
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What job categories do people searching Utilization Specialist jobs look for?

The top searched job categories for Utilization Specialist jobs are:

Utilization Specialist jobs near you
Infographic showing various Utilization Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $66,436 per year, or $31.9 per hour.

Utilization Specialist

Acadia Healthcare

Valdosta, GA • On-site

Full-time

Re-posted 18 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

698th of 898 rated healthcare providers

Job description

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  


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 

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. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

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

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About Acadia Healthcare

Sourced by ZipRecruiter

Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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