RN Utilization Management & Care Coordination

Wellstar Health System; Roswell (GA); On-site; USD 70,000 - 95,000; Full time

Job summary

Wellstar Health System in Georgia is seeking a skilled professional to join our utilization management team in Roswell. You will help assess necessity and appropriateness of health services, secure timely authorizations, monitor ongoing plans of care, and coordinate posts discharge documentation to ensure compliance with payer rules.

The role emphasizes collaboration with physicians and care teams, ongoing professional development, and mentoring of others to improve patient throughput and

Qualifications

• Strong clinical knowledge with clinical practice/experience.
• Medium to high verbal and written communication skills.
• High organizational skills and ability to build strong physician relationships.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services using screening criteria.
• Assesses insurance and coverage requirements for all payers and ensures adherence.
• Identifies issues and collaborates with physicians for admission resolution.
• Completes chart notes accurately and on time per protocol.
• Ensures timely documentation of clinical reviews and insurance updates.
• Supports continuous performance improvement and compliance with payer regulations.

Skills

Clinical knowledge

Communication skills

Organizational skills

Physician relationships

Screening criteria

Critical thinking

Computer skills

Job description

Wellstar Health System in Georgia is seeking a skilled professional to join our utilization management team in Roswell. You will help assess necessity and appropriateness of health services, secure timely authorizations, monitor ongoing plans of care, and coordinate posts discharge documentation to ensure compliance with payer rules.

The role emphasizes collaboration with physicians and care teams, ongoing professional development, and mentoring of others to improve patient throughput and