Behavioral Health Utilization Management Leader Systemwide

Piedmont Healthcare; Atlanta (GA); Hybrid; USD 120,000 - 150,000; Full time

Job summary

Piedmont Healthcare is seeking a senior leader to oversee Behavioral Health Utilization Review and Utilization Management across two hospital campuses and multiple BH programs. You will ensure compliant, effective UR operations that support appropriate care levels, medical necessity, and financial performance.

The role requires strong system-level leadership, collaboration with Revenue Cycle, Compliance, Finance, and Epic teams, and the ability to align utilization practices with regulatory and

Qualifications

• Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field is required.
• 5 years of experience in Behavioral Health Utilization Management and Utilization Review using medical necessity criteria (InterQual and/or Milliman).
• 2 years leadership/management experience in a hospital, medical practice, or healthcare setting is required.
• Experience in a system-level or multi-site environment is preferred.

Responsibilities

• Provide system-level leadership and oversight of BH UR and UM processes across campuses and programs.
• Ensure compliant UR operations supporting level-of-care determinations, medical necessity, and denial prevention.
• Collaborate with Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors and Executives to align utilization practices.

Education

Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field

Job description

Piedmont Healthcare is seeking a senior leader to oversee Behavioral Health Utilization Review and Utilization Management across two hospital campuses and multiple BH programs. You will ensure compliant, effective UR operations that support appropriate care levels, medical necessity, and financial performance.

The role requires strong system-level leadership, collaboration with Revenue Cycle, Compliance, Finance, and Epic teams, and the ability to align utilization practices with regulatory and