On-Site UM RN: Real-Time Care & Throughput Champion

Wellstar Health Systems, Inc.; Richmond (VA); Presencial; USD 85.000 - 105.000; Jornada completa

Descripción de la vacante

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse.

This RN will bridge the clinical floor and administrative compliance, performing admission and concurrent reviews to ensure appropriate Patient Class and optimize throughput, length of stay, and reimbursement. The role requires in-person collaboration with physicians, patients, and interdisciplinary teams to support medical necessity determinations and compliant care progression.

Formación

• RN licensure required: active state license (or compact).
• Minimum 3 years clinical experience in case management or utilization.
• Strong verbal and written communication capabilities.

Responsabilidades

• Physician collaboration: meet with providers to discuss cases needing documentation support.
• Real-time patient class decisions: participate in rounds and assess level of care.
• On-site compliance: perform medical necessity reviews using criteria like InterQual/MCG.
• Documentation: complete chart notes timely and accurately, ensure documentation is up-to-date.
• Post-discharge/post-bill: resolve accounts with no auth numbers and reconcile discrepancies.
• Professional development: complete mandatory education and mentor others.

Conocimientos

Case Management

Communication

Organizational Skills

Educación

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Diploma in Nursing

Descripción del empleo

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse.

This RN will bridge the clinical floor and administrative compliance, performing admission and concurrent reviews to ensure appropriate Patient Class and optimize throughput, length of stay, and reimbursement. The role requires in-person collaboration with physicians, patients, and interdisciplinary teams to support medical necessity determinations and compliant care progression.