Manager Utilization Management-Behavioral Health

Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance.

Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations. Qualifications Education Bachelor’s Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required Work Experience 5 years of experience in Behavioral Health Utilization Management and Utilization Review processes using medical necessity criteria (InterQual and/or Milliman). 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting Required Experience working in a system-level or multi-site environment Preferred Licenses and Certifications RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required or LPC-Licensed Professional Counselor Required or LMSW - Licensed Medical Social Worker - State Licensure Required or LCSW- License Clinical Social Worker Required or Licensed Marriage and Family Therapist (LMFT) Required IQCI Certification Required Business Unit : Company Name Piedmont Healthcare Corporate