On-Site UM RN: Influence Care & Throughput

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

Job summary

Wellstar Health System in Georgia seeks an on-site Hospital Utilization Management (UM) Nurse. You will act as the primary link between the clinical floor and administrative compliance, performing admission and concurrent reviews to ensure correct patient classification and care level.

This RN role emphasizes real-time collaboration with physicians, patients and multidisciplinary teams to optimize throughput, length of stay and reimbursement accuracy through daily bed huddles and bedside rounds.

Qualifications

• Knowledge of Case Management process.
• Excellent verbal and written communication skills.
• Strong organizational skills.
• Ability to build strong relationships with physicians and the multidisciplinary team.
• Knowledgeable with screening criteria in review of clinical data.
• Ability to think critically, analyze information and drive throughput.
• Strong computer skills.

Responsibilities

• Monitors and evaluates patient plans of care and conducts initial/concurrent reviews.
• Overturns denials by collaborating with physicians and advisors.
• Ensures compliance with Medicare/Medicaid regulations.
• Meet with providers to discuss documentation for medical necessity.
• Serve as on-site link between providers and physician advisor.
• Attend bedside rounds to provide input on care progression.
• Provide consults for ED admissions to determine level of care.

Skills

Case Management

Verbal Communication

Written Communication

Organizational Skills

Physician Collaboration

Screening Criteria

Critical Thinking

Computer Skills

Education

Associates/ Diploma in Nursing

BSN Preferred

Job description

Wellstar Health System in Georgia seeks an on-site Hospital Utilization Management (UM) Nurse. You will act as the primary link between the clinical floor and administrative compliance, performing admission and concurrent reviews to ensure correct patient classification and care level.

This RN role emphasizes real-time collaboration with physicians, patients and multidisciplinary teams to optimize throughput, length of stay and reimbursement accuracy through daily bed huddles and bedside rounds.