Onsite RN - Utilization Management Specialist

Wellstar Health System; Griffin (GA); On-site; USD 85,000 - 110,000; Full time

Job summary

Wellstar Health System in Georgia seeks an on-site Utilization Management Nurse (RN) to bridge clinical care and administrative compliance. This role performs admission and concurrent reviews to ensure correct patient class (Inpatient/Outpatient) and supports real-time throughput decisions.

You will collaborate with physicians, attend bedside rounds, and utilize criteria like InterQual/MCG to determine medical necessity, impacting stay length and reimbursement accuracy through direct, on-site

Qualifications

• Registered Nurse with current license.
• Experience with medical necessity determinations.
• On-site hospital utilization management knowledge.

Responsibilities

• Physician consultations in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or current level of care.
• Medical provider liaison: primary on-site link between attending/admitting provider and physician advisor for complex determinations.
• Attend daily bedside rounds or bedside huddles to provide input on medical necessity and care progression.
• Provide on-site reviews of active patient care using criteria like InterQual or MCG for medical necessity.
• Deliver and explain legally required documents in person, such as notifications related to level of care and observation status.

Skills

RN

On-site collaboration

Medicare/Medicaid compliance

Tools

InterQual/MCG

Job description

Wellstar Health System in Georgia seeks an on-site Utilization Management Nurse (RN) to bridge clinical care and administrative compliance. This role performs admission and concurrent reviews to ensure correct patient class (Inpatient/Outpatient) and supports real-time throughput decisions.

You will collaborate with physicians, attend bedside rounds, and utilize criteria like InterQual/MCG to determine medical necessity, impacting stay length and reimbursement accuracy through direct, on-site