On-Site Utilization Nurse: Elevate Care & Throughput

Wellstar Health System, Inc.; Crestdale (SC); Presencial; USD 85.000 - 105.000; Jornada completa

Descripción de la vacante

Wellstar Health System, Inc. seeks an on-site Hospital Utilization Management (UM) Nurse. You will link clinical floors with administrative compliance, conduct admission and concurrent reviews, and influence throughput, length of stay, and reimbursement accuracy.

This is an on-site role requiring direct provider interaction. Requirements include an active RN license, 3+ years of clinical experience, and familiarity with payer criteria.

Formación

• RN license in good standing in the relevant state.
• Minimum 3 years of clinical practice in a hospital setting.
• Experience with utilization management or care coordination is a plus.

Responsabilidades

• Meet in person with attending/admitting providers to discuss cases and ensure medical necessity.
• Function as the on-site liaison between providers and physician advisors for complex determinations.
• Attend daily bedside rounds to provide input on medical necessity and care progression.
• Provide consultation on cases admitted through the Emergency Department for appropriate level of care.
• Ensure documentation supports payer requirements and reduce denials.

Conocimientos

RN Clinical Knowledge

Interdisciplinary Collaboration

Medical Documentation

Educación

Associate Degree in Nursing

Bachelor of Science in Nursing

Herramientas

InterQual Criteria

MCG Guidelines

Descripción del empleo

Wellstar Health System, Inc. seeks an on-site Hospital Utilization Management (UM) Nurse. You will link clinical floors with administrative compliance, conduct admission and concurrent reviews, and influence throughput, length of stay, and reimbursement accuracy.

This is an on-site role requiring direct provider interaction. Requirements include an active RN license, 3+ years of clinical experience, and familiarity with payer criteria.