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

Wellstar Health Systems; Augusta (GA); On-site; USD 85,000 - 105,000; Full time

Job summary

Wellstar Health System is seeking an on-site Utilization Management Nurse (RN) to bridge the clinical floor and administrative compliance. This role directly influences hospital throughput and reimbursement by performing admission and concurrent reviews, with a strong emphasis on patient classification and care progression.

The ideal candidate brings at least 3 years of clinical experience, an RN license (state or compact), and BLS certification.

Qualifications

• Associates degree in nursing or diploma in nursing; a bachelor's in nursing is preferred.
• RN licensure in state or compact endorsement is required upon hire.
• Minimum of 3 years of clinical experience in a hospital or acute care setting.
• Basic Life Support (BLS) certification is required; additional certifications may be requested.

Responsibilities

• Collaborate in person with physicians and clinical teams to review medical necessity and level of care.
• Provide real-time input on medical necessity and care progression during rounds and huddles.
• Perform on-site concurrent reviews using criteria such as InterQual or MCG.
• Deliver and explain legally required documents (e.g., MOON, condition-code 44) in person.
• Ensure documentation accuracy and compliance to prevent payer disputes and denials.

Skills

Clinical knowledge

Documentation skills

RN licensure requirements

Education

Associates Degree in Nursing or Nursing Diploma, Bachelor's preferred

Job description

Wellstar Health System is seeking an on-site Utilization Management Nurse (RN) to bridge the clinical floor and administrative compliance. This role directly influences hospital throughput and reimbursement by performing admission and concurrent reviews, with a strong emphasis on patient classification and care progression.

The ideal candidate brings at least 3 years of clinical experience, an RN license (state or compact), and BLS certification.