Manager Utilization Management-Behavioral Health

Fayette Chamber of Commerce; Atlanta (GA); On-site; USD 110,000 - 170,000; Full time

Job summary

Piedmont Healthcare Corporate seeks a leader to oversee Behavioral Health Utilization Review and Utilization Management across multiple campuses. You will drive compliant UR operations, ensure medical necessity, and align practices with regulatory and payer expectations.

The role requires strong system-level oversight, collaboration with Revenue Cycle, Compliance, and Epic, and a track record in behavioral health utilization management.

Qualifications

• 5 years of experience in Behavioral Health Utilization Management and Utilization Review using medical necessity criteria (InterQual and/or Milliman).
• 2 years of leadership or management experience in a hospital, medical practice, or healthcare setting.

Responsibilities

• Provide system-level leadership and operational oversight of BH UR/UM across two hospital campuses and multiple programs.
• Collaborate with Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Leadership to align utilization practices with regulatory, payer, and organizational expectations.
• Ensure UR operations support appropriate level-of-care determinations, medical necessity, denial prevention, and financial performance.

Skills

Leadership

Healthcare operations

Education

Bachelor’s Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field

Tools

Epic

Job description

Responsibilities

Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance. Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations.

Qualifications

Education

• Bachelor’s Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required

Work Experience

• 5 years of experience in Behavioral Health Utilization Management and Utilization Review processes using medical necessity criteria (InterQual and/or Milliman).


• 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting Required


• Experience working in a system-level or multi-site environment Preferred

Licenses and Certifications

• RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required or


• LPC-Licensed Professional Counselor Required or


• LMSW - Licensed Medical Social Worker - State Licensure Required or


• LCSW- License Clinical Social Worker Required or


• Licensed Marriage and Family Therapist (LMFT) Required


• IQCI Certification Required

Business Unit : Company Name

Piedmont Healthcare Corporate