RN: On-Site Utilization & Care Optimizer

Wellstar Health System, Inc.; Harlem (GA); On-site; USD 75,000 - 95,000; Full time

Job summary

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance. You will perform admission and concurrent reviews to ensure correct patient class and optimize throughput, length of stay, and reimbursement.

The role requires direct, in-person interactions with doctors, patients, and interdisciplinary teams to influence care progression and ensure alignment with medical necessity criteria.

Qualifications

• Minimum 3 years strong clinical knowledge with clinical practice/experience.
• Associates nursing or diploma/bachelor’s preferred.

Responsibilities

• Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or current level of care.
• Function as the primary on-site link between the attending/admitting provider and the physician advisor for complex medical necessity determinations.
• Attend daily bedside rounds or departmental bed huddles to provide input on medical necessity and progression.
• Provide consultation on cases admitted through the Emergency Department for appropriate level of care.
• Ensure documentation supports medical necessity criteria (InterQual/MCG) and comply with payer regulations.

Education

Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System, Inc. is seeking an on-site Hospital Utilization Management (UM) Nurse to bridge clinical floors with administrative compliance. You will perform admission and concurrent reviews to ensure correct patient class and optimize throughput, length of stay, and reimbursement.

The role requires direct, in-person interactions with doctors, patients, and interdisciplinary teams to influence care progression and ensure alignment with medical necessity criteria.