RN Leader, Utilization Management & Care Coordination

Wellstar Health System; Blythe (GA); On-site; USD 90,000 - 125,000; Full time

Job summary

Wellstar Health System is seeking a senior leader to direct the Utilization Management program, ensuring optimal patient care and adherence to CMS and payer guidelines. The role requires collaboration with physicians, hospital departments, and executives to drive performance and compliance across the continuum of care.

The candidate will oversee education, outcomes management, and regulatory adherence while promoting a high-quality environment and teamwork across Wellstar facilities.

Qualifications

• Leadership experience in utilization management or similar healthcare program.
• Experience coordinating across physicians and hospital departments.

Responsibilities

• Oversee utilization management program operations and ensure compliance with CMS and payer standards.
• Lead performance management, staffing, reporting, and interdepartmental coordination.
• Coordinate patient care processes from admission to discharge; liaise with payers.
• Develop education materials and case management across pathways.
• Maintain budget and productivity measures.
• Represent the team in hospital and system committees.

Skills

Leadership

CMS compliance

Data analysis

Quality focus

Collaboration

Job description

Wellstar Health System is seeking a senior leader to direct the Utilization Management program, ensuring optimal patient care and adherence to CMS and payer guidelines. The role requires collaboration with physicians, hospital departments, and executives to drive performance and compliance across the continuum of care.

The candidate will oversee education, outcomes management, and regulatory adherence while promoting a high-quality environment and teamwork across Wellstar facilities.