RN Leader, Utilization Management

Wellstar Health System; Greenfield (SC); On-site; USD 90,000 - 130,000; Full time

Job summary

Wellstar Health System in South Carolina is seeking a dynamic leader to oversee the Utilization Management program, guiding staff and coordinating care from admission through discharge to achieve optimal patient outcomes.

This role emphasizes compliance with CMS and payer standards, data‑driven performance, and education, while collaborating with physicians and hospital teams to improve quality and cost efficiency across the continuum.

Responsibilities

• Oversees the Utilization Review program across admission to discharge.
• Maintains annual competency in review guidelines.
• Analyzes reports and financial metrics to guide decisions.
• Liaises with clinical departments to meet goals.
• Ensures CMS/commercial payer contract compliance.
• Participates in hospital committees to meet program requirements.

Job description

Wellstar Health System in South Carolina is seeking a dynamic leader to oversee the Utilization Management program, guiding staff and coordinating care from admission through discharge to achieve optimal patient outcomes.

This role emphasizes compliance with CMS and payer standards, data‑driven performance, and education, while collaborating with physicians and hospital teams to improve quality and cost efficiency across the continuum.