On-Site UM RN: Drive Throughput & Care Decisions

Wellstar Health Systems; Augusta (GA); On-site; USD 75,000 - 105,000; Full time

Job summary

Wellstar Health System in Georgia is seeking an on-site Utilization Management Nurse (RN) to bridge clinical care and administrative compliance. This role performs admission and concurrent reviews to ensure correct patient class and supports hospital throughput and reimbursement accuracy.

The position requires strong clinical knowledge, active RN licensure, and 3+ years of acute care experience, with a focus on medical necessity and payer requirements.

Qualifications

• Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred
• Requires active RN license and BLS certification
• Minimum 3 years strong clinical knowledge in relevant setting
• Experience with InterQual or MCG criteria for reviews

Responsibilities

• Perform on-site admission and concurrent reviews to determine medical necessity and appropriate level of care
• Collaborate with physicians and care teams to optimize hospital throughput and length of stay
• Deliver and explain required notices (e.g., MOON, condition-code 44) in person
• Identify opportunities for performance improvement and ensure compliance with payer regulations

Skills

Registered Nurse

Utilization Management

InterQual

MCG

Medicare/Medicaid

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Diploma in Nursing

Job description

Wellstar Health System in Georgia is seeking an on-site Utilization Management Nurse (RN) to bridge clinical care and administrative compliance. This role performs admission and concurrent reviews to ensure correct patient class and supports hospital throughput and reimbursement accuracy.

The position requires strong clinical knowledge, active RN licensure, and 3+ years of acute care experience, with a focus on medical necessity and payer requirements.