Clinical Utilization Review RN — Care Optimization & Payer Liaison

St. Mary's Health Care System; Athens (GA); On-site; USD 30,000 - 47,000; Part time

Job summary

St. Mary's Health Care System in Georgia seeks a part-time Utilization Review (UR) Coordinator to ensure patients receive the appropriate level of care and to optimize resource use across the continuum of hospitalization.

This role collaborates with physicians, nurses, patient access, billing, and external payers, conducts reviews against medical necessity criteria, and acts as a liaison to secure timely authorizations and effective communication with payers, always prioritizing compassionate,

Responsibilities

• Collaborates with physicians, nurses, patient access staff, billing personnel, and external payers to ensure patients receive the appropriate level of care throughout hospitalization.
• Conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and resource utilization.
• Acts as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, and authorization requirements.

Job description

St. Mary's Health Care System in Georgia seeks a part-time Utilization Review (UR) Coordinator to ensure patients receive the appropriate level of care and to optimize resource use across the continuum of hospitalization.

This role collaborates with physicians, nurses, patient access, billing, and external payers, conducts reviews against medical necessity criteria, and acts as a liaison to secure timely authorizations and effective communication with payers, always prioritizing compassionate,