On-Site Hospital Utilization Nurse: Real-Time Care & Compliance

Wellstar Health System; Martinez (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

Wellstar Health System is seeking an on-site Hospital Utilization Management (UM) Nurse to serve as the primary link between the clinical floor and administrative compliance. This role emphasizes real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams to optimize hospital resources and reimbursement accuracy.

Key responsibilities include physician consultations, on-site liaison to physician advisors, bedside rounds, ER throughput assessments, and concurrent

Qualifications

• RN licensure with active state license.
• Experience in utilization management preferred.
• On-site collaboration with care teams required.

Responsibilities

• Monitor and evaluate patient plans of care and perform concurrent reviews.
• Discuss cases with attending/admitting providers to justify medical necessity.
• Serve as on-site liaison between providers and physician advisor for determinations.
• Attend daily bedside rounds or bed huddles to provide input on care progression.
• Identify opportunities to overturn denials in collaboration with care teams.

Skills

Physician collaboration

Bedside rounds

Denials management

Medicare/Medicaid rules

On-site liaison

Education

Registered Nurse (RN)

Tools

InterQual

MCG

Job description

Wellstar Health System is seeking an on-site Hospital Utilization Management (UM) Nurse to serve as the primary link between the clinical floor and administrative compliance. This role emphasizes real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams to optimize hospital resources and reimbursement accuracy.

Key responsibilities include physician consultations, on-site liaison to physician advisors, bedside rounds, ER throughput assessments, and concurrent