BH Utilization Mgmt Coord-PMM

Piedmont Healthcare • Macon, GA

12d

About The Position

The Behavioral Health Utilization Management Coordinator ensures admitted patients have the appropriate level of care, patient status, authorization status, and plan of care, and meet medical necessity requirements for behavioral health services. The coordinator monitors patient progress against the plan of care and determines whether medical necessity continues to support continued stay. The role also ensures that payors receive the clinical information needed to authorize behavioral health services and continued stays, including covered days and associated services.

Requirements

• Bachelor’s degree from an accredited nursing school, or a B.A./B.S. degree; alternatively, a bachelor’s degree in social work.
• At least 2 years of experience in acute care, post-acute care, managed care, psychiatric care, or revenue cycle.
• Previous experience with InterQual and/or MCG guidelines.
• Previous experience in Utilization Management and/or Appeals.
• Previous Epic or Meditech/MIDAS experience.
• Previous experience in the prior authorization process.
• Current unrestricted RN license or LMSW/LCSW license in the state of Georgia, or LPC/LMFT; required upon hire.

Nice To Haves

• Master’s degree.
• Utilization Review or Care Management experience.
• CCM (Certified Case Manager), Case Management Certification, or American Case Management Association (ACMA) certification.

Responsibilities

• Ensure admitted patients have the appropriate level of care, patient status, authorization status, and plan of care.
• Ensure patients meet medical necessity requirements for behavioral health services.
• Monitor patient progress in the plan of care and whether medical necessity supports continued stay.
• Provide payors with clinical information needed to authorize behavioral health services and continued stays, including covered days and associated services.

What This Job Offers

• Job Type: Full-time