Impactful Behavioral Health Utilization Specialist

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

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.