System-Level Behavioral Health Utilization Leader

Piedmont Healthcare; 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

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.