D107 - C&A MH Crisis - Utilization Management Coordinator

River Edge; Macon (GA); On-site; USD 42,000 - 66,000; 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 meeting medical necessity, authorization, and documentation requirements. The role blends utilization review, care coordination, and authorization management within behavioral health services.

Located at 3575 Fulton Mill Road, Macon, GA, the position offers a path to contribute to discharge planning, authorizations, and UM processes, with a

Qualifications

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

Responsibilities

• Create Connects batch files for processing.
• Retrieve and process response files from Beacon’s SFTP site.
• Process Connects documents in states such as rejected, denied, hold, no CID, multi-finalpayer and status appropriately.
• Review discharge connects and flip to UM complete.
• Manage and update CareLogic with BHL CSU authorizations.
• Review and process AC files for BHL CSU authorization.
• Complete State Discharge process for Fulton locations.
• Create PTRF referrals via Beacon authorization requests.
• Review and process Connects documents in UM review.

Skills

Utilization management

Care coordination

Documentation

Education

High School Diploma

Bachelor's degree in helping profession

Job description

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-finalpayerand status appropriately

• Review discharge connects and flip to UM complete

• Manage and process BHL CSU authorizations and updateCarelogic

• 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 ofutilizationmanagement experience

Additional Benefits:

• Flexible spending accounts
• 11 Paid holidays

• Voluntary Life Insurance