On-Site Utilization Management RN - Improve Throughput

Wellstar Health Systems, Inc.; Richmond (VA); On-site; USD 85,000 - 110,000; Full time

Job summary

Wellstar Health System in Virginia is seeking an on-site Utilization Management Nurse. The RN serves as the primary liaison between the clinical floor and administrative compliance, influencing throughput, length of stay and reimbursement accuracy.

Responsibilities include physician collaboration, real-time decision support for patient class, on-site reviews using criteria such as InterQual/MCG, and delivering necessary notices in person. Requires RN licensure and 3+ years of clinical experience.

Qualifications

• Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred
• All certifications are required upon hire unless otherwise stated.
• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact
• BLS within 90 Days Required
• Minimum 3 years strong clinical knowledge with clinical practice/experience

Responsibilities

• Key On-Site Responsibilities: Physician and Clinical Collaboration, meet in person with providers to discuss cases where documentation does not support medical necessity or the current level of care.
• Medical Provider Liaison: act as the on-site link between attending/admitting provider and Physician Advisor for complex medical necessity determinations.
• Real-Time Patient Class Decision Support: attend bedside rounds to provide input on medical necessity and care progression; advise on ER admissions and appropriate level of care.
• Administrative & Financial Compliance: perform on-site concurrent reviews using InterQual/MCG; deliver MOONs and condition-code 44 documents; identify avoidable days to minimize financial loss.
• Documentation and Post Discharge: complete timely chart notes; ensure records are up-to-date; deliver required documents in person.
• Professional Development: complete competency assessments and mandatory education; serve as preceptor/mentor.

Skills

Clinical knowledge

Nursing experience

Education

Associate Degree in Nursing

Diploma in Nursing

Bachelor’s Degree in Nursing (Preferred)

Job description

Wellstar Health System in Virginia is seeking an on-site Utilization Management Nurse. The RN serves as the primary liaison between the clinical floor and administrative compliance, influencing throughput, length of stay and reimbursement accuracy.

Responsibilities include physician collaboration, real-time decision support for patient class, on-site reviews using criteria such as InterQual/MCG, and delivering necessary notices in person. Requires RN licensure and 3+ years of clinical experience.