Manager Utilization Management-Behavioral Health

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

Job summary

Piedmont Healthcare Corporate in Georgia seeks an experienced leader to oversee Behavioral Health Utilization Review (UR) and Utilization Management (UM) across two hospital campuses and multiple BH programs, including inpatient and ED-based services.

You will ensure compliant UR operations that support appropriate level-of-care determinations, medical necessity, denial prevention, and financial performance.

Qualifications

• Bachelor's degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field is required.
• 5+ years of Behavioral Health Utilization Management and Utilization Review experience using medical necessity criteria (InterQual and/or Milliman).
• 2+ years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting is required.
• Licenses: RN licensure or LPC/LMSW/LCSW/LMFT licensure or IQCI Certification are required.

Responsibilities

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

Education

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

Job description

Business Unit : Company Name: Piedmont Healthcare Corporate

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

• Bachelors 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