Utilization Mgmt Coord - Behavioral Health, PRN, Macon
On-siteMacon, Georgia, United States
Job Summary
Monitor admitted patients for appropriate level of care, authorization status, and medical necessity for behavioral health services. Ensure patient progress aligns with the plan of care and verify payor clinical information for service authorization and covered days. This role requires a Bachelor's degree in nursing or social work, two years of experience in acute, post-acute, or managed care psychiatric settings, and proficiency with InterQual/MCG guidelines, Epic/Meditech, and prior authorization processes. Candidates must hold a current Georgia RN license or LMSW/LCSW. Available for PRN shifts, the position mandates six shifts per month (three weekday, three weekend) and one holiday rotation in both spring/summer and fall/winter.
Required Qualifications
- Bachelor's Degree from an accredited nursing school, B.A/ B.S
- Bachelor's Degree in Social Work
- 2 years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle
- Previous experience with InterQual and/or MCG guidelines
- Previous experience in Utilization Management and/or Appeals
- Previous Epic experience or Meditech/MIDAS experience
- Previous experience in prior authorization process
- Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia
- LPC/LMFT
- 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
Desired Qualifications
- Master's degree
- Utilization Review or Care Management experience
- Case Management Certification (CCM) or American Case Management Association (ACMA) certification
Additional Requirements
- ALL PRN'S MUST BE AVAILABLE FOR 6 SHIFTS PER MONTH (3 WEEKDAY SHIFTS AND 3 WEEKEND SHIFTS)
- MUST WORK 1 HOLIDAY IN SPRING/SUMMER AND 1 HOLIDAY IN FALL/WINTER
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