Nurse Manager, Utilization & Care Coordination

Wellstar Health System; Grovetown (GA); On-site; USD 120,000 - 170,000; Full time

Job summary

Wellstar Health System seeks a seasoned Utilization Management leader to oversee the UM program's daily operations and strategic direction. You will coordinate care across admission to discharge, supervise staff, and partner with physicians and hospital departments to drive quality outcomes and cost-effective care.

The role emphasizes regulatory compliance, data-driven performance, staff engagement, and ongoing education to sustain excellence in utilization review practices.

Qualifications

• Bachelor's degree required; Master's preferred.
• 5+ years in Utilization Management leadership or equivalent.
• Experience with CMS and payer regulatory standards.

Responsibilities

• Provide leadership for the Utilization Management program and ensure quality patient care.
• Oversee program operations, staffing, budgets, and performance reporting.
• Collaborate with physicians and hospital departments to optimize care pathways.
• Ensure compliance with CMS/commercial payer standards and JOC/Regulatory bodies.
• Promote education, outcomes measurement, and process improvement.

Skills

Leadership

CMS compliance

Utilization Management

Data analysis

Cross-functional

Financial acumen

Education

Master's in Healthcare Administration

Tools

Epic

Meditech

Job description

Wellstar Health System seeks a seasoned Utilization Management leader to oversee the UM program's daily operations and strategic direction. You will coordinate care across admission to discharge, supervise staff, and partner with physicians and hospital departments to drive quality outcomes and cost-effective care.

The role emphasizes regulatory compliance, data-driven performance, staff engagement, and ongoing education to sustain excellence in utilization review practices.