Hospital Utilization RN — On-Site Care Liaison

Wellstar Health System; Vinings (GA); On-site; USD 85,000 - 105,000; Full time

Job summary

Wellstar Health System is seeking an on-site UM Nurse to bridge clinical care and administrative compliance. The role focuses on medical necessity, real-time decision support, and collaboration with physicians to optimize hospital resources.

Responsibilities include chart reviews, payer communications, and ensuring adherence to Medicare/Medicaid rules, with emphasis on reducing avoidable days and maintaining timely throughput.

Qualifications

• Knowledge of case management processes.
• Excellent verbal and written communication skills.
• Strong organizational abilities.
• Ability to build trusting relationships with physicians and the multidisciplinary team.
• Proficient with screening criteria in clinical data reviews.
• Critical thinking to analyze information and drive throughput.
• Strong computer skills.

Responsibilities

• Monitors and evaluates patient care plans and conducts initial and concurrent reviews.
• Oversees medical necessity decisions with physician advisors.
• Ensures compliance with Medicare/Medicaid regulations.
• Participates in daily bedside rounds and bed huddles.
• Identifies opportunities for performance improvement.
• Delivers on-site documentation and payer communications.

Skills

Case management knowledge

Verbal and written communication

Organizational skills

Relationship building with physicians

Screening criteria knowledge

Critical thinking

Computer skills

Education

Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System is seeking an on-site UM Nurse to bridge clinical care and administrative compliance. The role focuses on medical necessity, real-time decision support, and collaboration with physicians to optimize hospital resources.

Responsibilities include chart reviews, payer communications, and ensuring adherence to Medicare/Medicaid rules, with emphasis on reducing avoidable days and maintaining timely throughput.