Nurse Leader, Utilization Management & Outcomes

Wellstar Health System; North Augusta (GA); On-site; USD 120,000 - 180,000; Full time

Job summary

Wellstar Health System in Georgia seeks a strategic leader to direct the Utilization Management program. You will oversee UM operations, ensure CMS and payer compliance, and coordinate across physicians and hospital departments to maximize quality and efficiency in patient care.

Responsibilities include budgeting, staffing, performance analytics, and fostering staff engagement while aligning with organizational goals and regulatory requirements.

Qualifications

• Oversees UM program operations and ensures CMS payer standards are met.
• Leads admission-to-discharge coordination with physicians and hospital departments.
• Manages budget, staffing, and performance metrics for program success.

Responsibilities

• Coordinate UM program across the continuum from admission to discharge.
• Maintain competency with criteria review guidelines and annual UR reviews.
• Analyze UR reports, productivity data, and financial measures to guide decisions.
• Serve as liaison between clinical departments and payers on performance goals.
• Ensure compliance with CMS and commercial payor standards.

Skills

Leadership

Utilization Review

CMS Compliance

Financial Oversight

Staff Engagement

Interdepartmental Liaison

Job description

Wellstar Health System in Georgia seeks a strategic leader to direct the Utilization Management program. You will oversee UM operations, ensure CMS and payer compliance, and coordinate across physicians and hospital departments to maximize quality and efficiency in patient care.

Responsibilities include budgeting, staffing, performance analytics, and fostering staff engagement while aligning with organizational goals and regulatory requirements.