RN Utilization Management - FT/DAY - WMCG

Wellstar Health System; Grovetown (GA); On-site; USD 60,000 - 90,000; Full time

Job summary

Wellstar Health System is seeking an on-site Hospital Utilization Management (UM) Nurse. As an RN, you will bridge the clinical floor and administrative compliance, directly influencing throughput and reimbursement accuracy through real-time decisions.

You will collaborate with physicians, discharge planning, and interdisciplinary teams to determine the appropriate patient class and level of care on a daily basis.

Qualifications

• Must be a licensed RN (Registered Nurse).
• Strong communication and collaboration with clinical teams to optimize hospital resources.

Responsibilities

• 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: Serve as the on-site link between attending/admitting providers and the Physician Advisor for complex medical determinations.
• ER Throughput Management: Provide consultation on cases admitted through the Emergency Department to assess optimal level of care.
• Real-Time Patient Class Decision Support: Attend bedside rounds to provide input on medical necessity and patient class decisions.

Skills

Interdisciplinary collaboration

Clinical communication

Education

RN License or Compact 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