On-Site Utilization Management Nurse: Drive Throughput

Wellstar Health System; North Augusta (SC); On-site; USD 90,000 - 110,000; Full time

Job summary

Wellstar Health System is seeking an on-site Hospital Utilization Management Nurse to bridge clinical floors with administrative compliance. This role directly influences throughput, length of stay, and reimbursement accuracy through real-time collaboration with doctors and care teams.

Responsibilities include applying InterQual/MCG criteria, performing concurrent reviews, and delivering required notices in person.

Qualifications

• Utilization Management processes for hospital settings.
• Strong collaboration with physicians, patients, and interdisciplinary teams.
• Familiar with Medicare/Medicaid regulations and documentation standards.

Responsibilities

• Monitor and evaluate patient plans of care and conduct concurrent reviews.
• Serve as on-site liaison between attending providers and physician advisor for medical necessity determinations.
• Attend bedside rounds and bed huddles to provide input on medical necessity and care progression.
• Identify opportunities to reduce avoidable days and support performance improvement initiatives.

Job description

Wellstar Health System is seeking an on-site Hospital Utilization Management Nurse to bridge clinical floors with administrative compliance. This role directly influences throughput, length of stay, and reimbursement accuracy through real-time collaboration with doctors and care teams.

Responsibilities include applying InterQual/MCG criteria, performing concurrent reviews, and delivering required notices in person.