Mgr Utilization Mgmt-System

Piedmont; Atlanta (GA); On-site; USD 90,000 - 120,000; Full time

Job summary

Piedmont Healthcare Corporate is seeking an experienced nurse leader to oversee utilization management at the system level across sites. The role requires 5 years in hospital utilization management and proven staff leadership to guide professional teams.

You will ensure adherence to medical necessity criteria (InterQual and Milliman), collaborate with cross-functional partners, and improve review processes to support patient care and efficient utilization.

Qualifications

• Graduate from an accredited school of nursing.
• 5+ years of acute hospital utilization management experience, including leadership of professional staff.
• Experience with InterQual and Milliman criteria is expected.

Responsibilities

• Oversee system-level utilization management activities across sites.

Skills

Staff management

Medical necessity criteria (InterQual)

Education

Graduate from an accredited nursing program

Tools

InterQual

Milliman

Job description

Overview

System level matrix over site of the utilization management activities

Overview

System level matrix over site of the utilization management activities

Responsibilities

System level matrix over site of the utilization management activities

Qualifications

Education

• Graduate from a recognized, accredited school of nursing Required

Work Experience

• 5 years of experience with acute hospital utilization management and review processes, using medical necessity criteria (InterQual and/or Milliman), to include two (2) years of management experience of professional staff Required

Licenses and Certifications

• RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Current Georgia RN licensure Upon Hire Required and
• IQCI certification Upon Hire Required

Business Unit : Company Name:

Piedmont Healthcare Corporate