On-Site UM RN — Elevate Hospital Throughput & Care

Wellstar Health System, Inc.; North Augusta (GA); On-site; USD 85,000 - 115,000; Full time

Job summary

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse to serve as the critical link between the clinical floor and administrative compliance.

This RN will influence hospital throughput, length of stay, and reimbursement accuracy through real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams. The role requires an RN license, 3+ years of clinical experience, and BLS certification.

Qualifications

• Associates degree in nursing or diploma required; Bachelor's degree preferred.
• Active RN license (single state or compact) and BLS certification.
• Minimum 3 years of clinical nursing experience.

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.
• Serve as the on-site liaison between providers and the physician advisor for complex medical necessity determinations.
• Attend daily bedside rounds or bed huddles to provide input on medical necessity and care progression.
• Provide consultation for cases admitted through the Emergency Department to assess new admissions and recommended level of care.
• Ensure documentation supports medical necessity and adheres to payer regulations to prevent disputes.

Skills

Clinical nursing

InterQual/MCG knowledge

Communication

Education

Associates Nursing or Diploma in Nursing

Bachelor's Nursing - Preferred

Tools

InterQual

MCG

Job description

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse to serve as the critical link between the clinical floor and administrative compliance.

This RN will influence hospital throughput, length of stay, and reimbursement accuracy through real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams. The role requires an RN license, 3+ years of clinical experience, and BLS certification.