Onsite RN Utilization Manager — Hospital Throughput

Wellstar Health System, Inc.; United States; On-site; USD 75,000 - 95,000; Full time

Job summary

Wellstar Health System, Inc. in Georgia seeks an on-site Utilization Management Nurse (RN) to optimize hospital throughput and ensure medical necessity through real-time collaboration with physicians, patients, and interdisciplinary teams.

You will perform admission and concurrent reviews to align patient class with care needs and payer requirements. The role requires strong clinical knowledge and in-person communication to influence care progression, documentation accuracy, and reimbursement

Qualifications

• Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred.

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity.
• 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 department 'bed huddles' to provide input on medical necessity and care progression.
• Provide consultation on cases being admitted through the Emergency Department to assess new admissions and recommendations for level of care.
• Use InterQual or MCG criteria to perform on-site concurrent reviews of active patient care.
• Deliver and explain legally required documents in person, such as condition-code 44 or MOON.
• Identify 'avoidable days' hospital days and elevate them to management to minimize financial loss.
• Ensure compliance with payer regulations and that information is documented to prevent disputes and denials.

Skills

Clinical experience

Interdisciplinary collaboration

Documentation

Education

Associates Nursing or Diploma

Tools

InterQual/MCG criteria

Job description

Wellstar Health System, Inc. in Georgia seeks an on-site Utilization Management Nurse (RN) to optimize hospital throughput and ensure medical necessity through real-time collaboration with physicians, patients, and interdisciplinary teams.

You will perform admission and concurrent reviews to align patient class with care needs and payer requirements. The role requires strong clinical knowledge and in-person communication to influence care progression, documentation accuracy, and reimbursement