On-Site Utilization Management RN: Improve Throughput

Confidential; Augusta (GA); On-site; USD 80,000 - 110,000; Full time

Job summary

Wellstar is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge the clinical floor and administrative compliance. As an RN, you perform admission and concurrent medical record reviews to ensure appropriate patient class and level of care, directly influencing throughput, length of stay, and reimbursement.

You will collaborate in real time with physicians, patients, and care teams, participate in bedside rounds or bed huddles, and apply Medicare/Medicaid criteria

Qualifications

• Associates or Diploma in Nursing required or BSN preferred.
• RN license in appropriate state; Compact license acceptable.
• BLS certification required.
• Minimum 3 years of clinical knowledge and experience.

Responsibilities

• Perform on-site medical necessity reviews using criteria like InterQual/MCG.
• Collaborate with attending physicians, physician advisors and care teams.
• Attend bedside rounds or bed huddles to provide input on care progression.
• Ensure documentation supports medical necessity and compliance with payer rules.

Skills

RN clinical expertise

Interdisciplinary collaboration

Medical necessity assessment

Documentation proficiency

Education

Associates or Diploma in Nursing

Bachelor's in Nursing (BSN)

Job description

Wellstar is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge the clinical floor and administrative compliance. As an RN, you perform admission and concurrent medical record reviews to ensure appropriate patient class and level of care, directly influencing throughput, length of stay, and reimbursement.

You will collaborate in real time with physicians, patients, and care teams, participate in bedside rounds or bed huddles, and apply Medicare/Medicaid criteria