RN Utilization Management - FT/DAY - WMCG

Wellstar Health System; Blythe (GA); On-site; USD 80,000 - 110,000; Full time

Job summary

Wellstar Health System is seeking an on-site Utilization Management (UM) Nurse. The RN will perform admission and concurrent medical record reviews to ensure correct Patient Class (Inpatient vs. Observation).

This role directly influences throughput, length of stay, and reimbursement accuracy. Responsibilities include physician consultations, acting as the on-site liaison with Physician Advisor, and supporting ER throughput with real-time decisions.

Qualifications

• Active RN license in good standing
• Experience in hospital utilization management or clinical-administrative liaison preferred
• Ability to collaborate across physicians, nurses, and administration

Responsibilities

• Physician Consultation: meet in person with attending providers to discuss documentation and medical necessity.
• Medical Provider Liaison: serve as the on-site link between attending providers and Physician Advisor.
• ER Throughput Management: advise on admissions from the Emergency Department to ensure appropriate level of care.
• Attend bedside rounds/
• Provide input on medical necessity during interdisciplinary huddles and rounds

Skills

Registered Nurse

Education

RN License

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Day (United States of America)

Job Summary:

As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between the clinical floor and administrative compliance. Unlike remote roles, this position relies heavily on real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams to optimize hospital resources. The on-site UM Nurse is a Registered Nurse (RN) responsible for performing admission and concurrent medical record reviews to ensure patients are in the correct Patient Class (e.g., Inpatient vs. Outpatient with Observation). By being physically present, one is able to directly influence the hospital's throughput, length of stay, and reimbursement accuracy.

Key On-Site Responsibilities Physician and Clinical Collaboration

• Physician Consultation: Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.
• Medical Provider Liaison: Function as the primary on-site link between the attending/admitting provider and the Physician Advisor for complex medical necessity determinations.
• ER Throughput Management: Provide consultation as needed on cases being admitted through the Emergency Department to assess new admissions and recommendations for the most appropriate level of care.

Real-Time Patient Class Decision Support

• Interdisciplinary Huddles: Attend daily bedside rounds or departmental "bed huddles" to provide immediate input on medical necessity and