Senior Leader, Behavioral Health Utilization Management

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

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.