On-Site Utilization Management RN: Drive Care & Throughput

Wellstar Health System, Inc.; Greenfield (SC); On-site; USD 78,000 - 110,000; Full time

Job summary

Wellstar Health System, Inc. in the United States seeks an on-site Utilization Management Nurse (RN) to bridge the clinical floor and administrative compliance. This role performs admission and concurrent medical record reviews to ensure appropriate patient class (Inpatient vs.

Outpatient with Observation) and directly influences hospital throughput, length of stay, and reimbursement accuracy. The UM RN collaborates with physicians and interdisciplinary teams in person, participates in daily

Qualifications

• Associates degree or nursing diploma required.
• BSN preferred where available.
• Experience with utilization management processes.

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or current level of care.
• Function as the primary on-site link between attending/admitting provider and physician advisor for complex medical necessity determinations.
• Attend daily bedside rounds or bed huddles to provide input on medical necessity and care progression.
• Provide consultation on cases admitted through the Emergency Department to assess level of care.
• Perform on-site concurrent reviews using criteria like InterQual or MCG.

Skills

RN license

InterQual/MCG

Clinical liaison

Throughput optimization

Education

Associate Degree in Nursing

BSN preferred

Job description

Wellstar Health System, Inc. in the United States seeks an on-site Utilization Management Nurse (RN) to bridge the clinical floor and administrative compliance. This role performs admission and concurrent medical record reviews to ensure appropriate patient class (Inpatient vs.

Outpatient with Observation) and directly influences hospital throughput, length of stay, and reimbursement accuracy. The UM RN collaborates with physicians and interdisciplinary teams in person, participates in daily