Nurse Manager, Utilization Management

Wellstar Health System; Augusta (GA); On-site; USD 110,000 - 150,000; Full time

Job summary

Wellstar Health System seeks a senior leader to oversee the Utilization Management program. You will guide operations from admission to discharge, ensure compliance with CMS and payer standards, and coordinate with physicians and hospital departments to optimize care and outcomes.

The role emphasizes staff development, data-driven improvement, and education material creation, with a focus on cost-effective, high-quality patient care.

Qualifications

• Experience leading Utilization Management programs and teams.
• Understanding of CMS and payer regulatory requirements.
• Ability to interpret UR criteria and apply evidence-based guidelines.

Responsibilities

• Lead UM program operations from admission through discharge and follow-up.
• Maintain competency in clinical review guidelines and annual updates.
• Analyze UR reports and financial metrics to drive improvements.
• Act as liaison between clinical departments and payers; ensure contract compliance.
• Oversee daily program operations in collaboration with physicians and leadership.
• Promote a productive environment; monitor staff morale and performance.
• Develop education materials and coordinate case management across care pathways.

Skills

Leadership

Program management

Regulatory compliance

Communication

Data analysis

Collaboration

Job description

Wellstar Health System seeks a senior leader to oversee the Utilization Management program. You will guide operations from admission to discharge, ensure compliance with CMS and payer standards, and coordinate with physicians and hospital departments to optimize care and outcomes.

The role emphasizes staff development, data-driven improvement, and education material creation, with a focus on cost-effective, high-quality patient care.