RN Manager, Utilization Management Leader

Wellstar Health System; Hephzibah (GA); On-site; USD 110,000 - 140,000; Full time

Job summary

Wellstar Health System in Georgia seeks a senior leader to oversee the Utilization Management program, setting standards of practice, adopting evidence-based guidelines, and ensuring CMS and payer compliance to deliver high-quality patient care.

You will drive financial performance, staff engagement, and cross-department collaboration with physicians, discharge planners, and hospital leadership to optimize outcomes, cost effectiveness, and program performance.

Qualifications

• Leads utilization management with CMS and payer compliance.
• Drives program performance through data analysis and reporting.
• Manages budgets, staffing and performance metrics.
• Collaborates with physicians, discharge planners and leadership.

Responsibilities

• Lead the UM program across admission to discharge and follow-up.
• Maintain competency with criteria review and annual training.
• Analyze UM reports, productivity and financial data for decisions.
• Serve as liaison between clinical departments to meet goals.
• Ensure CMS/commercial payer standards and contract compliance.
• Promote staff morale, teamwork and performance improvement.
• Coordinate education and outcomes management across care paths.
• Oversee regulatory compliance and participation in committees.

Skills

Leadership

Utilization Management

CMS Standards

Financial Management

Staff Engagement

Interdepartmental Collaboration

Communication

Job description

Wellstar Health System in Georgia seeks a senior leader to oversee the Utilization Management program, setting standards of practice, adopting evidence-based guidelines, and ensuring CMS and payer compliance to deliver high-quality patient care.

You will drive financial performance, staff engagement, and cross-department collaboration with physicians, discharge planners, and hospital leadership to optimize outcomes, cost effectiveness, and program performance.