BH Utilization Mgmt Coord-PMM

Role Overview

This position ensures 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.

What You Will Do

Monitor patient progress, ensure patient payor has clinical information to authorize behavioral health services, and manage continued stay services.

Why It Might Be a Fit

The ideal candidate will have experience in utilization management, appeals, and prior authorization processes, with a strong background in nursing or social work.

Requirements

• Bachelor’s Degree from an accredited nursing school or B.A/B.S.
• 2 years of experience in acute, post-acute, managed care, psychiatric, or revenue cycle
• Previous experience with InterQual and/or MCG guidelines
• Previous experience in Utilization Management and/or Appeals
• Previous Epic experience or Meditech/MIDAS experience
• Previous experience in prior authorization process
• Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia
• CCM – Certified Case Manager Case Management Certification (CCM) or American Case Management Association (ACMA) certification