RN Utilization & Care Management Lead

Wellstar Health System; Augusta (GA); On-site; USD 110,000 - 150,000; Full time

Job summary

WellStar Health System in Georgia seeks an experienced Utilization Management leader to oversee the program, implement evidence-based guidelines, and ensure CMS and payer compliance while guiding quality patient care.

You will manage a multidisciplinary team, collaborate with physicians and hospital leadership, develop education resources, monitor performance metrics, and drive cost-effective care across the continuum.

Qualifications

• Bachelor's Degree in a related field with 3+ years managing multidisciplinary staff.
• Experience in hospital environment and case management.
• Knowledge of CMS and payer standards.

Responsibilities

• Lead Utilization Management program and ensure adherence to standards.
• Coordinate with physicians and hospital leadership to optimize patient care and throughput.
• Ensure regulatory compliance and contract requirements.
• Develop education materials and performance dashboards.

Skills

Leadership

Healthcare management

Regulatory compliance

Communication

Team management

Education

Bachelor's Degree

Job description

WellStar Health System in Georgia seeks an experienced Utilization Management leader to oversee the program, implement evidence-based guidelines, and ensure CMS and payer compliance while guiding quality patient care.

You will manage a multidisciplinary team, collaborate with physicians and hospital leadership, develop education resources, monitor performance metrics, and drive cost-effective care across the continuum.