Onsite Hospital Utilization Nurse for Throughput and Care

Wellstar Health System; North Augusta (GA); On-site; USD 90,000 - 115,000; Full time

Job summary

Wellstar Health System in Georgia is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance and optimize hospital resources. You will work directly with physicians and interdisciplinary teams to influence throughput and reimbursement accuracy.

In this role you will meet with attending providers to discuss documentation supporting medical necessity, serve as the on-site link to the physician adviser, attend bedside rounds, and

Qualifications

• On-site UM nurse collaborates with physicians to discuss documentation supporting medical necessity or appropriate level of care.
• Real-time input during bed huddles to support care progression and throughput.
• Uses criteria like InterQual or MCG to perform concurrent reviews of active patient care.

Responsibilities

• Meet in person with attending providers to discuss cases where documentation does not support medical necessity or current level of care.
• Function as the primary on-site link between the attending provider and the physician advisor for complex medical necessity determinations.
• Attend daily bedside rounds or bed huddles to provide input on medical necessity and criteria-led care progression.
• Provide consultation for cases being admitted through the Emergency Department to assess new admissions and appropriate level of care.

Job description

Wellstar Health System in Georgia is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance and optimize hospital resources. You will work directly with physicians and interdisciplinary teams to influence throughput and reimbursement accuracy.

In this role you will meet with attending providers to discuss documentation supporting medical necessity, serve as the on-site link to the physician adviser, attend bedside rounds, and