On-Site UM Nurse: Real-Time Care Optimization

Wellstar Health System; Mableton (GA); On-site; USD 85,000 - 105,000; Full time

Job summary

Wellstar Health System in Georgia seeks an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance. This role emphasizes real-time, face-to-face interaction with doctors, patients, and the care team to optimize hospital resources.

The RN UM Nurse conducts concurrent reviews, participates in bedside rounds, and ensures documentation supports medical necessity while meeting payer requirements and improving throughput.

Qualifications

• Associates degree in Nursing or Nursing diploma; BSN preferred.
• Active Georgia RN license.
• Minimum 3 years of clinical experience in a hospital setting.

Responsibilities

• Monitors and evaluates patient care plans with initial and concurrent reviews.
• Identifies avoidable hospital days and liaises with management.
• Attends bedside rounds and provides input on medical necessity.
• Ensures payer documentation and compliance with regulations.
• Collaborates with physicians and the care team to optimize throughput.

Skills

Case Management

Communication

Organizational skills

Critical thinking

Computer skills

Team collaboration

Education

Associates Nursing

Diploma in Nursing

BSN preferred

Job description

Wellstar Health System in Georgia seeks an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance. This role emphasizes real-time, face-to-face interaction with doctors, patients, and the care team to optimize hospital resources.

The RN UM Nurse conducts concurrent reviews, participates in bedside rounds, and ensures documentation supports medical necessity while meeting payer requirements and improving throughput.