Nurse Manager, Utilization & Care Quality

2310 AU Medical Center, Inc.; United States; On-site; USD 110,000 - 170,000; Full time

Job summary

Wellstar in Georgia seeks an accomplished leader to oversee the Utilization Management program and ensure CMS and payer compliance. You will manage staff, coordinate with physicians and hospital departments, and drive quality and throughput improvements across the continuum of care.

The role requires 3+ years of hospital-based management experience, strong regulatory knowledge, and the ability to build collaborative, cross-functional teams to improve patient outcomes and cost efficiency.

Qualifications

• Bachelor's Degree required.
• Minimum 3 years experience managing a multidisciplinary staff in case management.
• Minimum 3 years experience in a hospital environment.

Responsibilities

• Provide leadership and operational management of the Utilization Management program.
• Ensure compliance with CMS and payer requirements and utilization review standards.
• Coordinate program functions with physicians and hospital departments to optimize quality and throughput.
• Lead quality improvement initiatives and monitor program performance metrics.
• Serve on hospital committees and liaise with regulatory bodies and payers.

Skills

Leadership

Staff management

Utilization Management

Hospital environment

Education

Bachelor's Degree

Job description

Wellstar in Georgia seeks an accomplished leader to oversee the Utilization Management program and ensure CMS and payer compliance. You will manage staff, coordinate with physicians and hospital departments, and drive quality and throughput improvements across the continuum of care.

The role requires 3+ years of hospital-based management experience, strong regulatory knowledge, and the ability to build collaborative, cross-functional teams to improve patient outcomes and cost efficiency.