On-Site Utilization Management RN - Throughput & Care

Wellstar Health System, Inc.; North Augusta (SC); On-site; USD 80,000 - 110,000; Full time

Job summary

Wellstar Health System, Inc. seeks an on-site Utilization Management Nurse (RN) to bridge clinical floors with administrative compliance. You will perform admission and concurrent reviews to ensure correct patient classification and optimize throughput.

You will work closely with providers, physician advisors, and interdisciplinary teams to improve care progression, reimbursement accuracy, and payer alignment through on-site collaboration.

Qualifications

• Associates degree, diploma or BSN in nursing.
• RN license valid in the United States.
• BLS certification required.
• Minimum 3 years clinical nursing experience.

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.
• Function as the on-site link between the attending/admitting provider and the Physician Advisor for complex medical necessity determinations.
• Attend daily bedside rounds or departmental '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.
• Use criteria like InterQual or MCG to perform on-site concurrent reviews.
• Deliver and explain legally required documents such as MOON.
• Identify 'avoidable days' and escalate to management to minimize financial loss.

Skills

Clinical knowledge

Interdisciplinary collaboration

RN professional practice

Documentation accuracy

Education

Associates/Diploma in Nursing or Bachelors Nursing (Preferred)

Job description

Wellstar Health System, Inc. seeks an on-site Utilization Management Nurse (RN) to bridge clinical floors with administrative compliance. You will perform admission and concurrent reviews to ensure correct patient classification and optimize throughput.

You will work closely with providers, physician advisors, and interdisciplinary teams to improve care progression, reimbursement accuracy, and payer alignment through on-site collaboration.