Utilization Mgmt Coord - Behavioral Health, PRN, Macon

Piedmont; Macon (GA); On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare provider in Macon, Georgia is seeking a professional to ensure admitted patients receive the appropriate level of care and authorization for behavioral health services. This role requires monitoring patient progress and ensuring necessary clinical information for continued stay authorization is provided. Candidates should have a relevant bachelor's degree and at least 2 years of experience in healthcare settings. A valid RN license or LMSW/LCSW in Georgia is required for this position.

Qualifications

• RN license or LMSW/LCSW in Georgia is required.
• 2 years of experience in a related field is required.
• Case Management Certification (CCM) is preferred.

Responsibilities

• Ensure patients have appropriate level of care.
• Monitor patient progress in their care plan.
• Ensure clinical information is available for authorizations.

Skills

Experience in acute care

Utilization Management

InterQual/MGC guidelines

Prior authorization process

Education

Bachelor's Degree from an accredited nursing school

Bachelor's Degree in Social Work

Master's Degree

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 ensures 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 ensures 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

• Bachelors Degree from an accredited nursing school, B.A/ B.S or Required or
• Bachelors Degree in Social Work Required or
• Masters 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