Behavioral Health Utilization Specialist

River Edge Behavioral Health; Macon (GA); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Flexible spending accounts

11 Paid holidays

Voluntary Life Insurance

Job summary

River Edge Behavioral Health in Macon, GA seeks an Utilization Management Coordinator to ensure appropriate care levels and compliance. The role combines utilization review, care coordination, and insurance authorization management within behavioral health services.

The position involves batch processing, file retrieval from Beacon, and updating Carelogic for CSU authorizations, with a focus on discharge and UM review workflows.

Qualifications

• 1–3 years of utilization management experience.
• High School Diploma required; Bachelor's in helping profession preferred.

Responsibilities

• Create Connects batch files.
• Retrieve and process response files from Beacon’s SFTP site.
• Work Connects documents in rejected, denied, hold, no CID, multi-final payer and status appropriately.
• Review discharge connects and flip to UM complete.
• Manage and process BHL CSU authorizations and update Carelogic.
• Review and process AC file for BHL CSU authorization.
• Complete State Discharge process for Fulton locations.
• Create PTRF referral via Beacon authorization request.
• Review and process Connects documents in UM review.

Tools

Carelogic

Job description

River Edge Behavioral Health in Macon, GA seeks an Utilization Management Coordinator to ensure appropriate care levels and compliance. The role combines utilization review, care coordination, and insurance authorization management within behavioral health services.

The position involves batch processing, file retrieval from Beacon, and updating Carelogic for CSU authorizations, with a focus on discharge and UM review workflows.