Behavioral Health Utilization Manager

Piedmont Healthcare; Macon (GA); On-site; USD 70,000 - 95,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a clinician to ensure admitted behavioral health patients receive appropriate care and meet medical necessity for continued stay and authorizations.

The role tracks progress of the plan of care and ensures payor information supports authorization for continued services, including covered days. The ideal candidate holds an RN in GA or LMSW/LCSW, or LPC/LMFT, with experience in Utilization Management and guidelines such as InterQual/MCG.

Qualifications

• Bachelor’s degree from an accredited nursing school and RN licensure in GA.
• Bachelor’s degree in Social Work required; Master’s degree preferred.
• 2 years in acute/post-acute/managed care, or revenue cycle required.
• Experience with InterQual and/or MCG guidelines required.
• Experience in Utilization Management and/or Appeals preferred.
• Current/unrestricted RN license or LMSW/LCSW in GA; LPC/LMFT also acceptable.

Responsibilities

• Ensure admitted patients receive appropriate level of care and meet medical necessity.
• Monitor progress of patient plan of care and continued stay authorizations.
• Provide payer with clinical information to authorize services and covered days.

Education

Bachelor's Degree - nursing (RN)

Bachelor's Degree in Social Work

Master's Degree Preferred

Tools

Epic

Meditech

MIDAS

InterQual/MCG guidelines

Prior authorization systems

Job description

Piedmont Healthcare Corporate is seeking a clinician to ensure admitted behavioral health patients receive appropriate care and meet medical necessity for continued stay and authorizations.

The role tracks progress of the plan of care and ensures payor information supports authorization for continued services, including covered days. The ideal candidate holds an RN in GA or LMSW/LCSW, or LPC/LMFT, with experience in Utilization Management and guidelines such as InterQual/MCG.