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 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. 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 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. Qualifications: 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

Job Tags

Full time, Work experience placement

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