On‑Site Utilization Management RN — Drive Throughput & Care

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

Job summary

Wellstar Health System is seeking an on-site Hospital Utilization Management (UM) Nurse. The RN will review admissions and concurrent medical records to ensure appropriate patient class and optimal hospital throughput.

This role requires in-person collaboration with physicians, patients, and interdisciplinary teams to support compliant, efficient care. The position emphasizes real-time decision-making, bedside rounds participation, and proactive identification of opportunities to improve

Qualifications

• Active RN license in Georgia
• Minimum 3 years clinical experience in hospital setting
• Experience with utilization management/medical review processes preferred
• Knowledge of Medicare/Medicaid regulations and payer requirements

Responsibilities

• Meet with on-site providers to discuss cases where documentation does not support medical necessity
• Serve as on-site link between clinicians and physician advisor for complex determinations
• Participate in daily bedside rounds to input on medical necessity and care progression
• Provide on-site consultation for ER admissions and appropriate level of care
• Conduct on-site concurrent reviews using InterQual/MCG criteria
• Deliver and explain required notices (e.g., MOON) in person
• Identify avoidable days and communicate potential denials risks to management

Skills

RN license

InterQual/MCG criteria

Communication

Discharge planning

Education

Associates/Bachelor of Nursing

Tools

EMR systems

Job description

Wellstar Health System is seeking an on-site Hospital Utilization Management (UM) Nurse. The RN will review admissions and concurrent medical records to ensure appropriate patient class and optimal hospital throughput.

This role requires in-person collaboration with physicians, patients, and interdisciplinary teams to support compliant, efficient care. The position emphasizes real-time decision-making, bedside rounds participation, and proactive identification of opportunities to improve