Behavioral Health Utilization Specialist

Piedmont Healthcare, Inc.; Macon (GA); On-site; USD 75,000 - 110,000; Full time

Job summary

Piedmont Healthcare, Inc. is seeking a skilled Utilization Management professional to ensure appropriate levels of care for behavioral health patients. You will verify medical necessity, monitor progress, and coordinate with payors to secure authorizations for continued stays and services.

The role requires experience with InterQual/MCG guidelines, prior authorization, and familiarity with Epic or Meditech/MIDAS. A nursing or social work background with relevant licenses is essential.

Qualifications

• Bachelor's degree in nursing required.
• Bachelor's degree in social work required.
• Master's degree preferred.
• 2 years of clinical/utilization management experience required.
• Experience with InterQual/MCG guidelines required.
• Experience in utilization management or appeals required.
• Epic or Meditech/MIDAS experience required.
• Prior authorization process experience required.
• Utilization review or care management experience preferred.
• GA RN license, LMSW/LCSW, or LPC/LMFT at hire required.

Responsibilities

• Ensure admitted patients have appropriate level of care and meet medical necessity for behavioral health services.
• Monitor patient progress in the plan of care and continued stay.
• Provide payor with clinical information to authorize services and continuation of coverage.

Skills

Utilization Management

Care Management

Prior Authorization

InterQual/MCG guidelines

Education

Bachelor’s Degree in Nursing

Bachelor’s Degree in Social Work

Master’s Degree

Tools

Epic

Meditech/MIDAS

Job description

Piedmont Healthcare, Inc. is seeking a skilled Utilization Management professional to ensure appropriate levels of care for behavioral health patients. You will verify medical necessity, monitor progress, and coordinate with payors to secure authorizations for continued stays and services.

The role requires experience with InterQual/MCG guidelines, prior authorization, and familiarity with Epic or Meditech/MIDAS. A nursing or social work background with relevant licenses is essential.