What are the responsibilities and job description for the BH Utilization Mgmt Coord-PMM position at Piedmont?
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
Piedmont Healthcare Corporate
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 Required or
- Bachelor's Degree in Social Work Required
- Master's Degree Preferred
- 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
- Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Upon Hire Required or
- LPC/LMFT also acceptable Upon Hire Required
- CCM - Certified Case Manager Case Management Certification (CCM) or American Case Management Association (ACMA) certification Preferred
Piedmont Healthcare Corporate