Full employer posting
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 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.
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 Business Unit : Company Name Piedmont Healthcare Corporate
About the role
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.