Utilization Specialist - Acute

The Utilization Specialist at Carolina Dunes Behavioral Health reviews admissions, continued stays, and discharge planning using clinically valid criteria to obtain authorizations and ensure appropriate utilization. The role coordinates utilization management activities, communicates with payers and clinical staff, and provides education and reporting to support reimbursement and quality initiatives. It focuses on ensuring medical necessity, managing appeals, and improving processes related to patient length of stay and payment coordination.