Impactful UM Nurse - PRN Days

Wellstar Health System, Inc.; North Augusta (SC); On-site; USD 75,000 - 110,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for a PRN Days schedule. The role entails medical necessity reviews, care coordination, and timely authorizations for a defined patient population.

Expect collaboration with physicians, payers, and care teams, with responsibilities spanning admission reviews, post-discharge follow-up, and compliance under MCg criteria. The UM Coordinator will use mcg Indicia, communicate findings, and ensure proper

Qualifications

• Strong clinical knowledge and experience in medical necessity reviews.
• Ability to coordinate care and facilitate safe transitions.
• Experience with EPIC and payer communications.
• Knowledge of MCg Indicia criteria.

Responsibilities

• Conduct medical necessity reviews 24/7 using established criteria.
• Share authorization status with care teams and payers.
• Perform utilization review for new admissions, observations, and concurrent cases.
• Obtain timely authorization of ALOS days and document in EPIC.
• Communicate with providers and payors to resolve discrepancies.
• Monitor post-discharge/prebill accounts and ensure accurate documentation.

Skills

Nursing

Utilization review

Care coordination

EPIC proficiency

MCG criteria

Education

Registered Nurse (RN)

Tools

EPIC EHR

MCG Indicia

Payer communications

Job description

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for a PRN Days schedule. The role entails medical necessity reviews, care coordination, and timely authorizations for a defined patient population.

Expect collaboration with physicians, payers, and care teams, with responsibilities spanning admission reviews, post-discharge follow-up, and compliance under MCg criteria. The UM Coordinator will use mcg Indicia, communicate findings, and ensure proper