Onsite RN UM: Hospital Throughput & Compliance

WellStar Health System; United States; Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

Wellstar Health System seeks an on-site Hospital Utilization Management (UM) Nurse. The RN acts as the primary link between the clinical floor and administrative compliance, performing admission and concurrent chart reviews to ensure correct patient class and care level.

You will influence throughput, length of stay, and reimbursement accuracy by working directly with doctors and care teams. You will collaborate with physicians, attend bedside rounds, and provide real-time input on medical

Qualifications

• RN license in good standing and state nursing credentials.
• Minimum 3 years of clinical hospital experience.
• Associates or Diploma in Nursing; Bachelor's preferred.
• Current BLS certification.

Responsabilités

• Meet in person with physicians to discuss cases where documentation does not support medical necessity or current level of care.
• Collaborate with attending/admitting providers, physician advisors, and care teams on complex determinations.
• Attend bedside rounds to provide input on medical necessity and care progression.
• Perform on-site medical necessity reviews and ensure payer requirements are met.
• Deliver required notices in person, e.g. MOON or condition-code 44 when needed.

Connaissances

Clinical knowledge

Interdisciplinary collaboration

Documentation accuracy

Formation

Associate Degree in Nursing

Diploma in Nursing

Bachelor of Science in Nursing

RN license (state)

BLS certification

Description du poste

Wellstar Health System seeks an on-site Hospital Utilization Management (UM) Nurse. The RN acts as the primary link between the clinical floor and administrative compliance, performing admission and concurrent chart reviews to ensure correct patient class and care level.

You will influence throughput, length of stay, and reimbursement accuracy by working directly with doctors and care teams. You will collaborate with physicians, attend bedside rounds, and provide real-time input on medical