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
• Ensure consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance
• Serve 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) (Required)
• 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 - Licensed Clinical Social Worker (Required) or
• Licensed Marriage and Family Therapist (LMFT) (Required)
• IQCI Certification (Required)