On-Site RN Utilization Management Specialist

WellStar Health System; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Wellstar Health System is hiring an on-site Utilization Management (UM) Nurse. As a Registered Nurse, you will bridge the clinical floor and administrative compliance, focusing on admission and concurrent reviews to ensure appropriate patient classification.

You will work closely with attending physicians, care teams, and a physician advisor to resolve medical necessity determinations. Real-time bedside rounds, bed huddles, and ER admit reviews drive throughput and accurate reimbursement.

Qualifications

• Active RN license in the United States.
• Minimum 3 years clinical nursing experience.
• Experience with medical necessity criteria (InterQual/MCG) preferred.
• Strong collaboration with physicians and care teams.

Responsibilities

• Perform admission and concurrent medical record reviews to assess level of care.
• Collaborate with physicians and physician advisor for complex determinations.
• Attend daily rounds and bed huddles to influence throughput.
• Explain notices and ensure documentation compliance.

Skills

RN experience

Medical record review

InterQual criteria

Education

ASN or Diploma in Nursing

Job description

Wellstar Health System is hiring an on-site Utilization Management (UM) Nurse. As a Registered Nurse, you will bridge the clinical floor and administrative compliance, focusing on admission and concurrent reviews to ensure appropriate patient classification.

You will work closely with attending physicians, care teams, and a physician advisor to resolve medical necessity determinations. Real-time bedside rounds, bed huddles, and ER admit reviews drive throughput and accurate reimbursement.