BH Utilization Mgmt Coord-PMM

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

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