Impactful Utilization Management Nurse — PRN Days

Wellstar Health System, Inc.; Blythe (GA); On-site; USD 60,000 - 90,000; Full time

Job summary

Wellstar Health System, Inc. seeks a Utilization Management Nurse (UM) Coordinator for PRN days at Cobb Hospital. The role focuses on medical necessity reviews, coordination of care transitions, and timely authorizations using MC G Indicia and EPIC.

The UM Nurse collaborates with payers and care teams to determine appropriate levels of care while ensuring documentation compliance and efficient post-discharge processes.

Qualifications

• Minimum 3 years of strong clinical knowledge/experience.
• Experience performing medical necessity reviews and utilization management tasks.

Responsibilities

• Conduct medical necessity reviews 24/7 with clinical criteria (MCG).
• Coordinate with payers and care teams for authorizations and levels of care.
• Ensure documentation in EPIC and communication with providers and payors.
• Monitor post-discharge and prebill accounts for authorizations and variances.
• Advocate for patients and ensure compliance with payer regulations.

Skills

Strong clinical knowledge

Utilization management

Tools

EPIC

MCG Indicia

Job description

Wellstar Health System, Inc. seeks a Utilization Management Nurse (UM) Coordinator for PRN days at Cobb Hospital. The role focuses on medical necessity reviews, coordination of care transitions, and timely authorizations using MC G Indicia and EPIC.

The UM Nurse collaborates with payers and care teams to determine appropriate levels of care while ensuring documentation compliance and efficient post-discharge processes.