Behavioral Health Utilization Navigator

Piedmont-Healthcare; Snellville (GA); On-site; USD 70,000 - 100,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a professional to manage utilization and care coordination for behavioral health services. The role ensures appropriate level of care, tracks medical necessity, and secures authorizations for continued stay with payer information.

Required RN license in Georgia or LMSW/LCSW; bachelor’s degrees in nursing or social work; master’s degree preferred. Epic/Meditech/MIDAS experience and prior authorization experience are highly valued.

Qualifications

• 2 years of experience in acute, post-acute, managed care, psychiatric, or revenue cycle.
• InterQual and/or MCG guidelines knowledge required.
• Utilization Review or Care Management experience preferred.
• Epic experience or Meditech/MIDAS experience required.
• Prior authorization process experience required.

Responsibilities

• Ensure admitted patients have appropriate level of care and medical necessity.
• Monitor progress in plan of care and authorization status for continued stay.
• Provide clinical information to payors for authorization of services.

Skills

Utilization management

Care coordination

Education

Bachelor’s Degree in Nursing

Bachelor’s Degree in Social Work

Master’s degree

RN license GA

LMSW/LCSW

Tools

Epic

Meditech

MIDAS

Job description

Piedmont Healthcare Corporate is seeking a professional to manage utilization and care coordination for behavioral health services. The role ensures appropriate level of care, tracks medical necessity, and secures authorizations for continued stay with payer information.

Required RN license in Georgia or LMSW/LCSW; bachelor’s degrees in nursing or social work; master’s degree preferred. Epic/Meditech/MIDAS experience and prior authorization experience are highly valued.