RN Utilization Management: Elevate Patient Care

Wellstar Health System, Inc.; Roswell (GA); On-site; USD 80,000 - 100,000; Full time

Job summary

Wellstar Health System, Inc. seeks an experienced Utilization Management Nurse to perform medical necessity reviews up to 12 hours daily, seven days a week, using MCG Indicia criteria and EPIC documentation.

You will collaborate with physicians and the care team to coordinate safe transitions of care for a defined patient population. Responsibilities include daily reviews of admissions, observations, and concurrent cases; securing authorizations, documenting thoroughly, and communicating with

Qualifications

• RN with active license in Georgia (or compact state).
• Experience with utilization management and case management preferred.
• Knowledge of EPIC and MCG criteria.

Responsibilities

• Perform medical necessity reviews up to 12 hours daily.
• Conduct reviews using Indicia criteria and coordinate with care team.
• Obtain timely authorizations and document in EPIC.
• Communicate determinations to physicians, payers, and teams.

Skills

Clinical knowledge

Verbal and written communication

Organizational skills

Relationship building

Screening criteria

Analytical thinking

Computer skills

Education

Associates degree in Nursing or Nursing diploma

Bachelor's in Nursing - Preferred

Job description

Wellstar Health System, Inc. seeks an experienced Utilization Management Nurse to perform medical necessity reviews up to 12 hours daily, seven days a week, using MCG Indicia criteria and EPIC documentation.

You will collaborate with physicians and the care team to coordinate safe transitions of care for a defined patient population. Responsibilities include daily reviews of admissions, observations, and concurrent cases; securing authorizations, documenting thoroughly, and communicating with