BH Utilization Mgmt Coord-PMM

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

Overview

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

Responsibilities

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

Qualifications

Education

• Bachelor’s Degree from an accredited nursing school, B.A/ B.S Required or
• Bachelor’s Degree in Social Work Required
• Master’s Degree Preferred

Work Experience

• 2 years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle Required
• Previous experience with InterQual and/or MCG guidelines Required
• Previous experience in Utilization Management and/or Appeals Required
• Previous Epic experience or Meditech/MIDAS experience Required
• Previous experience in prior authorization process Required
• Utilization Review or Care Management experience Preferred

Licenses and Certifications

• Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Upon Hire Required or
• LPC/LMFT also acceptable Upon Hire Required
• CCM - Certified Case Manager Case Management Certification (CCM) or American Case Management Association (ACMA) certification Preferred

Business Unit : Company Name

Piedmont Healthcare Corporate