On-Site Utilization Management RN — Real-Time Care & Compliance

Wellstar Health System; Georgia; On-site; USD 75,000 - 95,000; Full time

Job summary

Wellstar Health System in Georgia is seeking an on-site Hospital Utilization Management (UM) Nurse. You will perform admission and concurrent medical record reviews to ensure patients are in the correct class (Inpatient vs Outpatient with Observation) and influence throughput, LOS, and reimbursement accuracy.

The role requires direct collaboration with physicians, attendance at bedside rounds or bed huddles, and on-site communication to resolve cases.

Qualifications

• Active RN license required (single state) or RN-Compact multi-state license
• Current Basic Life Support (BLS) certification required
• Familiar with InterQual criteria for medical necessity reviews
• Familiar with MCG guidelines for concurrent reviews
• Knowledge of Medicare/Medicaid regulations and payer requirements

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.
• Serve as the on-site link between attending providers and physician advisor for complex medical determinations.
• Attend bedside rounds or bed huddles to provide input on medical necessity and care progression.
• Perform on-site concurrent reviews of active patient care using established criteria (e.g., InterQual, MCG).
• Deliver and explain required notices such as MOON or condition-code 44 in person.
• Identify and communicate opportunities to avoid unnecessary hospital days and support denial prevention and throughput improvements.

Skills

RN

BLS

InterQual

MCG

Medicare regulations

Education

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

Job description

Wellstar Health System in Georgia is seeking an on-site Hospital Utilization Management (UM) Nurse. You will perform admission and concurrent medical record reviews to ensure patients are in the correct class (Inpatient vs Outpatient with Observation) and influence throughput, LOS, and reimbursement accuracy.

The role requires direct collaboration with physicians, attendance at bedside rounds or bed huddles, and on-site communication to resolve cases.