Behavioral Health Utilization Specialist

Piedmont; Macon (GA); On-site; USD 75,000 - 105,000; Full time

Job summary

Piedmont is seeking a qualified professional to ensure admitted patients receive appropriate care and meet medical necessity for behavioral health services. You will monitor progress in the plan of care and ensure the payor has the clinical information to authorize continued treatment and covered days.

The role requires GA licensure (RN or LMSW/LCSW; LPC/LMFT also acceptable) and 2 years of related experience, with familiarity in InterQual/MCG guidelines and prior authorization processes.

Qualifications

• RN license or LMSW/LCSW in Georgia required
• LPC/LMFT also acceptable Upon Hire
• 2 years of experience in acute/post-acute/managed care/psychiatric/revenue cycle required
• Experience with InterQual and/or MCG guidelines required
• Experience in Utilization Management and/or Appeals required
• Prior authorization process experience required
• Utilization Review or Care Management experience preferred

Responsibilities

• Ensure admitted patients have appropriate level of care and plan of care
• Verify medical necessity for behavioral health services and continued stay
• Ensure payor has clinical information to authorize services and covered days
• Monitor patient progress in plan of care and authorization status
• Prepare/document information for payor review and authorization decisions

Skills

Utilization Management

Authorization Process

InterQual/MCG guidelines

Prior Authorization

Epic

Meditech/MIDAS

Revenue Cycle

Education

Bachelor's Degree (Nursing)

Bachelor's Degree in Social Work

Master's Degree (Preferred)

Tools

Epic software

Meditech/MIDAS

Job description

Piedmont is seeking a qualified professional to ensure admitted patients receive appropriate care and meet medical necessity for behavioral health services. You will monitor progress in the plan of care and ensure the payor has the clinical information to authorize continued treatment and covered days.

The role requires GA licensure (RN or LMSW/LCSW; LPC/LMFT also acceptable) and 2 years of related experience, with familiarity in InterQual/MCG guidelines and prior authorization processes.