RN Utilization Management: Care Coordination Leader

Wellstar Health System, Inc.; United States; On-site; USD 80,000 - 105,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse to conduct medical necessity reviews up to 12 hours per day across 7 days per week.

You will utilize Indicia criteria and EPIC documentation to determine appropriate care levels, coordinate with physicians, and ensure timely authorizations for hospital admissions and discharges. The role emphasizes collaboration with care teams, payer communications, and post-discharge follow-up to optimize patient outcomes and ensure

Qualifications

• Associates Nursing or Diploma (Nurse) or Bachelors Nursing preferred.
• RN license (single state or compact) required at hire.
• BLS certification required upon hire.
• Minimum 3 years of clinical experience.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services using established criteria (e.g., MCG).
• Performs timely certification/authorization of hospital admissions and days.
• Communicates with payers and documents actions accurately in EPIC.
• Monitors post-discharge/prebill accounts to resolve authorization or discrepancy issues.
• Escalates denials and collaborates with physicians and care teams to optimize care.

Skills

Clinical experience

Interdisciplinary collaboration

Documentation

Education

Associate's Nursing or Diploma (Nurse) or Bachelors Nursing

Tools

EPIC

Job description

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse to conduct medical necessity reviews up to 12 hours per day across 7 days per week.

You will utilize Indicia criteria and EPIC documentation to determine appropriate care levels, coordinate with physicians, and ensure timely authorizations for hospital admissions and discharges. The role emphasizes collaboration with care teams, payer communications, and post-discharge follow-up to optimize patient outcomes and ensure