Mgr Utilization Mgmt-System

Piedmont Healthcare Inc.; Atlanta (GA); On-site; USD 95,000 - 125,000; Full time

Job summary

Piedmont Healthcare Corporate seeks an experienced nurse leader to oversee utilization management at system level. Requires GA RN licensure and IQCI certification, with at least 5 years in hospital utilization management and 2 years in supervising professional staff.

Strong knowledge of InterQual and Milliman criteria is preferred. This role emphasizes governance, coordination across sites, and ensuring medical necessity reviews align with standards.

Qualifications

• Graduate from an accredited school of nursing (RN).
• 5 years of acute hospital utilization management experience.
• 2 years of management experience of professional staff.
• RN Georgia licensure current upon hire; GA or multistate licensure.
• IQCI certification upon hire.

Skills

Management experience

Leadership

Education

Graduate from accredited nursing program

Tools

InterQual

Milliman

Job description

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