Piedmont Healthcare Inc.
Location
Macon, Georgia
The Utilization Management Coordinator ensures admitted behavioral health patients meet medical necessity criteria and appropriate levels of care. They also manage the authorization process with payors to ensure continued stay coverage and clinical documentation compliance.
Candidates must hold a Bachelor's degree in Nursing or Social Work and possess a current unrestricted license in Georgia. At least two years of experience in acute, psychiatric, or managed care settings with proficiency in InterQual, MCG, and prior authorization processes is required.
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.
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. **ALL PRN'S MUST BE AVAILABLE FOR 6 SHIFTS PER MONTH (3 WEEKDAY SHIFTS AND 3 WEEKEND SHIFTS). DAY SHIFTS ONLY. MUST WORK 1 HOLIDAY IN SPRING/SUMMER AND 1 HOLIDAY IN FALL/WINTER**
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
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