Description:
JOB PURPOSE:
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 patients 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:
MINIMUM EDUCATION REQUIRED:
Degree from an accredited nursing school, B.A/ B.S or LMSW/LCSW/LPC/LMFT.

MINIMUM EXPERIENCE REQUIRED:
Two (2) years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia.
LPC/LMFT also acceptable.

ADDITIONAL QUALIFICATIONS:
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.
Preferred: Case Management Certification (CCM) or American Case Management Association
(ACMA) certification.
Masters degree and three (3) years of Utilization Review or Care Management experience
desired.