On-Site Utilization Management RN: Care & Throughput

Wellstar Health System; Woodstock (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

Wellstar Health System is seeking an on-site Hospital Utilization Management Nurse (RN) to serve as a critical link between clinical floors and administrative compliance. You will perform admission and concurrent reviews to ensure appropriate patient placement, influence throughput, and support accurate reimbursement.

The role emphasizes in-person collaboration with physicians, interdisciplinary teams, and bedside rounds to optimize care and adhere to payer criteria.

Qualifications

• Associates Nursing or diploma (Nurse) or Bachelors in Nursing is preferred.
• Strong knowledge of case management process and care coordination.
• Excellent verbal and written communication; able to collaborate with multidisciplinary teams.

Responsibilities

• Conduct on-site medical necessity reviews using criteria like InterQual/MCG.
• Consult with attending/admitting providers in person to align documentation with medical necessity and level of care.
• Attend daily bedside rounds and bed huddles to provide input on treatment progression.
• Identify avoidable days and work with management to minimize financial loss.
• Ensure timely and accurate documentation of clinical reviews and insurance updates.

Skills

Case management

Verbal and written communication

Organizational skills

Relationship building with physicians

Critical thinking

Screening criteria knowledge

Education

Associates Nursing or Diploma (Nurse); Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System is seeking an on-site Hospital Utilization Management Nurse (RN) to serve as a critical link between clinical floors and administrative compliance. You will perform admission and concurrent reviews to ensure appropriate patient placement, influence throughput, and support accurate reimbursement.

The role emphasizes in-person collaboration with physicians, interdisciplinary teams, and bedside rounds to optimize care and adhere to payer criteria.