D107 - C&A MH Crisis - Utilization Management Coordinator

River Edge Behavioral Health; Macon (GA); On-site; USD 42,000 - 60,000; 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 is seeking an Utilization Management Coordinator to ensure appropriate behavioral health care levels while maintaining compliance with medical necessity and documentation requirements. The role blends utilization review, care coordination, and insurance authorization management within behavioral health services.

Qualified candidates will have a High School Diploma and 1-3 years of UM experience; a Bachelor's in a helping profession is preferred.

Qualifications

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

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

Skills

Utilization management experience

Education

High School Diploma

Bachelor's degree preferred

Job description

About River Edge Behavioral Health

Serving more than 10,000 Georgians, River Edge continues to be one of the state's leading resources for mental health, substance use disorder treatments and supports as well as individuals with intellectual and development disabilities. River Edge offers outpatient services at our Emery Highway-Macon, Monroe County and Baldwin County locations. Outpatient services include behavioral health, nursing, and psychiatric assessment, stabilization and medication maintenance services as well as crisis intervention services as well as awareness, education and recovery groups.

Utilization Management Coordinator

Company Overview

At River Edge Behavioral Health in Macon, GA, employees are expected to develop meaningful relationships with patients, establishing trust and making a difference in the lives of clients and their families. We believe in supporting our team as well as our clients with our comprehensive benefits package and a supportive work culture, including health, dental, and vision benefits, paid vacation, retirement plans, and more.

Position Overview

The Utilization Management Coordinator role is focused on ensuring clients receive the appropriate level of behavioral health care while maintaining compliance with medical necessity, authorization, and documentation requirements. The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services.

Location/Schedule

3575 Fulton Mill Road, Macon, GA.

Key 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

Qualifications

• High School Diploma (Bachelors in helping profession such as social work, community counseling, counseling psychology, or criminology preferred)
• 1-3 years of utilization management experience

Additional Benefits

• Flexible spending accounts
• 11 Paid holidays
• Voluntary Life Insurance

We are an equal opportunity employer and highly value diversity. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

All selected applicants must pass a satisfactory background clearance and pre-employment drug test.