Utilization Mgmt Coord - Behavioral Health

Piedmont Healthcare • Snellville, GA

7d

About The Position

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 the 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.

Requirements

• Bachelor’s Degree from an accredited nursing school, B.A/ B.S or Required or Bachelor’s Degree in Social Work Required
• 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
• Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Required or LPC/LMFT also acceptable Required

Nice To Haves

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

Responsibilities

• 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.
• Monitor that the patient is progressing in their plan of care and meet medical necessity for continued stay.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level