PRN Day-Shift Utilization Management Nurse

Wellstar Health System, Inc.; Crestdale (SC); On-site; USD 69,000 - 96,000; Part time

Job summary

Wellstar Health System, Cobb Hospital in Georgia, is seeking a Utilization Management Nurse (UM) Coordinator for PRN days. You will perform daily medical necessity reviews, coordinate with payers, and support safe transitions of care.

You will work with EPIC and MCG criteria, monitor authorizations and ALOS, and collaborate with physicians and care teams to ensure timely approvals and compliant documentation.

Qualifications

• Minimum 3 years of strong clinical knowledge and clinical practice/experience.

Responsibilities

• Perform daily medical necessity reviews using established criteria (e.g. MCG).
• Coordinate with payers and care team to obtain timely authorizations.
• Ensure accurate documentation of reviews and insurance updates in EPIC.
• Monitor ALOS and post-discharge/prebill accounts for authorization gaps.
• Escalate issues to management as needed and communicate with providers.

Skills

Strong clinical knowledge

Clinical practice/experience

Tools

EPIC

MCG Indicia

Job description

Wellstar Health System, Cobb Hospital in Georgia, is seeking a Utilization Management Nurse (UM) Coordinator for PRN days. You will perform daily medical necessity reviews, coordinate with payers, and support safe transitions of care.

You will work with EPIC and MCG criteria, monitor authorizations and ALOS, and collaborate with physicians and care teams to ensure timely approvals and compliant documentation.