On-Site UM Nurse (RN) — Optimize Throughput & Care

Wellstar Health Systems, Inc.; Marietta (GA); On-site; USD 70,000 - 95,000; Full time

Job summary

Wellstar Health Systems, Inc. is seeking an on-site Utilization Management Nurse (RN) in Georgia. You will lead in-person medical necessity reviews, collaborate with physicians, and support bed huddles to optimize throughput and reimbursement accuracy.

The role emphasizes direct patient care alignment, adherence to InterQual/MCG criteria, and proactive denial prevention. On-site presence is required to influence care decisions and resource use.

Qualifications

• Associates degree in Nursing or nursing diploma required; BSN preferred.
• Active RN license in Georgia or Compact state; BLS required.
• Minimum 3 years clinical experience in hospital or utilization management.

Responsibilities

• Perform admission and concurrent medical record reviews to verify medical necessity.
• Collaborate with physicians and staff to determine appropriate level of care.
• Attend daily rounds and bed huddles for real-time decisions.
• Ensure compliance with payer regulations and documentation accuracy.

Skills

Case Management

Communication

Organization

Physician relationships

Screening criteria

Critical thinking

Computer skills

Education

Associates Nursing

Diploma Nursing

Bachelors Nursing (Preferred)

Tools

MCG

InterQual

Job description

Wellstar Health Systems, Inc. is seeking an on-site Utilization Management Nurse (RN) in Georgia. You will lead in-person medical necessity reviews, collaborate with physicians, and support bed huddles to optimize throughput and reimbursement accuracy.

The role emphasizes direct patient care alignment, adherence to InterQual/MCG criteria, and proactive denial prevention. On-site presence is required to influence care decisions and resource use.