Utilization Mgmt Coord - Behavioral Health

Piedmont-Healthcare; Snellville (GA); On-site; USD 70,000 - 100,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking a professional to manage utilization and care coordination for behavioral health services. The role ensures appropriate level of care, tracks medical necessity, and secures authorizations for continued stay with payer information.

Required RN license in Georgia or LMSW/LCSW; bachelor’s degrees in nursing or social work; master’s degree preferred. Epic/Meditech/MIDAS experience and prior authorization experience are highly valued.

Qualifications

• 2 years of experience in acute, post-acute, managed care, psychiatric, or revenue cycle.
• InterQual and/or MCG guidelines knowledge required.
• Utilization Review or Care Management experience preferred.
• Epic experience or Meditech/MIDAS experience required.
• Prior authorization process experience required.

Responsibilities

• Ensure admitted patients have appropriate level of care and medical necessity.
• Monitor progress in plan of care and authorization status for continued stay.
• Provide clinical information to payors for authorization of services.

Skills

Utilization management

Care coordination

Education

Bachelor’s Degree in Nursing

Bachelor’s Degree in Social Work

Master’s degree

RN license GA

LMSW/LCSW

Tools

Epic

Meditech

MIDAS

Job description

Overview

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

Responsibilities

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

Qualifications

Education

• Bachelor’s Degree from an accredited nursing school, B.A/ B.S or Required or
• Bachelor’s Degree in Social Work Required or
• Master’s degree Preferred

Work Experience

• 2 years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle Required
• Previous experience with InterQual and/or MCG guidelines Required
• Previous experience in Utilization Management and/or Appeals Required
• Previous Epic experience or Meditech/MIDAS experience Required
• Previous experience in prior authorization process Required
• Utilization Review or Care Management experience Preferred

Licenses and Certifications

• Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Required or
• LPC/LMFT also acceptable Required

Additional Licenses and Certifications

• Case Management Certification (CCM) or American Case Management Association (ACMA) certification Preferred

Business Unit : Company Name

Piedmont Healthcare Corporate