Onsite UM Nurse: Real-Time Care & Compliance

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

Job summary

Wellstar Health System is seeking an on-site Utilization Management Nurse to serve as the pivotal link between the clinical floor and administrative compliance. You will engage with doctors, patients, and multidisciplinary teams to optimize hospital resources and ensure medical necessity while navigating payer requirements.

Responsibilities include bedside rounds, physician liaison duties, and on-site reviews using InterQual/MCG criteria.

Qualifications

• RN with current license in Georgia or multi-state license
• Strong verbal and written communication skills
• Experience in case management or utilization management is preferred

Responsibilities

• Act as on-site liaison between clinical teams and physician advisors
• Participate in daily rounds and bed huddles to determine appropriate levels of care
• Perform concurrent reviews using criteria like InterQual or MCG
• Explain and deliver required payer notices in person
• Identify and escalate opportunities to improve throughput and reduce unnecessary days
• Ensure documentation meets payer requirements and reduces potential denials

Skills

Communication

Organizational skills

Relationship building

Analytical thinking

Computer skills

Education

ASN/Diploma in Nursing

BSN preferred

Tools

EMR systems

MS Office

Job description

Wellstar Health System is seeking an on-site Utilization Management Nurse to serve as the pivotal link between the clinical floor and administrative compliance. You will engage with doctors, patients, and multidisciplinary teams to optimize hospital resources and ensure medical necessity while navigating payer requirements.

Responsibilities include bedside rounds, physician liaison duties, and on-site reviews using InterQual/MCG criteria.