Nurse Manager, Utilization Review

Wellstar Health Systems; Augusta (GA); On-site; USD 95,000 - 135,000; Full time

Job summary

Wellstar Health Systems is seeking a leader for the Utilization Management program to drive clinical quality, compliance, and efficiency across the continuum of care at our Augusta, GA campus.

The role requires directing staff, aligning with physicians and hospital leadership, and ensuring adherence to CMS and payer standards while delivering cost-effective, evidence-based patient care.

Qualifications

• Bachelor's Degree REQUIRED; 3+ years managing a multidisciplinary case-management staff.
• Hospital experience required; able to lead across departments.
• Knowledge of CMS and payer regulations; focus on compliance.
• Strong leadership, communication and collaboration skills.

Responsibilities

• Oversee the Utilization Management program operations.
• Coordinate program with physicians and hospital departments to ensure quality outcomes.
• Ensure CMS/commercial payer compliance and regulatory reporting.
• Promote staff engagement and meet organizational financial and service goals.
• Liaise with regulatory bodies and hospital committees as needed.

Skills

Leadership

CMS compliance

Utilization Review

Stakeholder coordination

Education

Bachelor's Degree

Job description

Wellstar Health Systems is seeking a leader for the Utilization Management program to drive clinical quality, compliance, and efficiency across the continuum of care at our Augusta, GA campus.

The role requires directing staff, aligning with physicians and hospital leadership, and ensuring adherence to CMS and payer standards while delivering cost-effective, evidence-based patient care.