RN Manager, Utilization Review & Case Management

Wellstar Health System, Inc.; Augusta, Northern (GA, KY); Hybrid; USD 95,000 - 120,000; Full time

Job summary

Wellstar Health System, Inc. seeks an RN Manager for Utilization Review to lead the Utilization Management program in Augusta. This role ensures adherence to CMS and payer guidelines, drives quality and cost-effective care, and partners with physicians and hospital departments to optimize patient throughput.

The position emphasizes leadership, staff development and data-driven improvement across admission through discharge, with a focus on regulatory compliance and outcomes-based performance.

Qualifications

• Bachelor's degree in nursing (Registered Nurse).
• Minimum 3 years in management of a multidisciplinary staff in case management within a hospital.
• Experience with Utilization Review, CMS and payer regulatory standards.

Responsibilities

• Lead and manage the Utilization Management program.
• Ensure compliance with CMS and payer standards.
• Oversee financial performance, HR management and staff engagement.
• Coordinate with physicians and hospital departments to optimize patient care and throughput.
• Develop education materials and case management across the care continuum.
• Promote regulatory compliance and quality improvement initiatives.

Skills

Leadership

Team collaboration

Communication

Regulatory awareness

Education

Bachelor's degree

Job description

Wellstar Health System, Inc. seeks an RN Manager for Utilization Review to lead the Utilization Management program in Augusta. This role ensures adherence to CMS and payer guidelines, drives quality and cost-effective care, and partners with physicians and hospital departments to optimize patient throughput.

The position emphasizes leadership, staff development and data-driven improvement across admission through discharge, with a focus on regulatory compliance and outcomes-based performance.