Manager Utilization Management-Behavioral Health

Piedmont-Healthcare; Atlanta (GA); On-site; USD 120,000 - 160,000; Full time

Job summary

Piedmont Healthcare is seeking a senior leader to oversee Behavioral Health Utilization Review and Utilization Management across two hospital campuses and multiple BH programs, including inpatient and ED services.

You will drive compliant UR operations, determine medical necessity, prevent denials, and support financial performance while partnering with Revenue Cycle, Compliance, Finance, Epic, and executive leadership to align utilization practices with regulatory expectations.

Qualifications

• Bachelor's degree in Nursing, Business Administration, Health Administration, Social Work, or related field required.
• Minimum 5 years of experience in Behavioral Health Utilization Management and Utilization Review using medical necessity criteria (InterQual and/or Milliman).
• At least 2 years of leadership/management experience in a hospital, medical practice, or healthcare setting.

Responsibilities

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

Skills

Leadership

Collaboration

Healthcare operations

Education

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

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