Manager Utilization Management-Behavioral Health

Piedmont Healthcare; Atlanta (GA); Hybride; USD 120 000 - 150 000; Plein temps

Résumé du poste

Piedmont Healthcare is seeking a senior leader to oversee Behavioral Health Utilization Review and Utilization Management across two hospital campuses and multiple BH programs. You will ensure compliant, effective UR operations that support appropriate care levels, medical necessity, and financial performance.

The role requires strong system-level leadership, collaboration with Revenue Cycle, Compliance, Finance, and Epic teams, and the ability to align utilization practices with regulatory and

Qualifications

• Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field is required.
• 5 years of experience in Behavioral Health Utilization Management and Utilization Review using medical necessity criteria (InterQual and/or Milliman).
• 2 years leadership/management experience in a hospital, medical practice, or healthcare setting is required.
• Experience in a system-level or multi-site environment is preferred.

Responsabilités

• Provide system-level leadership and oversight of BH UR and UM processes across campuses and programs.
• Ensure compliant UR operations supporting level-of-care determinations, medical necessity, and denial prevention.
• Collaborate with Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors and Executives to align utilization practices.

Formation

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

Description du poste

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