RN Utilization Management: Impactful Care & Approvals

Wellstar Health System, Inc.; Harlem (GA); On-site; USD 55,000 - 76,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for weekend shifts at Cobb Hospital. The role involves medical necessity reviews, authorizations, and coordination with the care team to ensure safe transitions of care.

Strong clinical knowledge and EPIC documentation are required. Minimum 3 years of clinical experience is required. The UM Nurse will review admissions, observations, and concurrent cases using MCG and IEF criteria to determine appropriate level of care

Qualifications

• Associates degree or nursing diploma; RN licensure required.
• Bachelors in Nursing preferred for advancement.

Responsibilities

• Conduct medical necessity reviews using established criteria.
• Obtain timely authorizations for hospital admissions and days.
• Document reviews and communication in EPIC and with payors.
• Monitor post-discharge/prebill accounts for discrepancies.
• Perform concurrent reviews and determine appropriate level of care.
• Collaborate with physicians, care team, and payors to optimize care transitions.
• Maintain compliance with Medicare/Medicaid regulations and policies.

Skills

Case Management

Verbal & Written Communication

Organizational Skills

Collaboration with physicians

Screening criteria knowledge

Critical thinking

Computer skills

Education

Associates or Diploma in Nursing

Bachelor’s in Nursing - Preferred

Job description

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for weekend shifts at Cobb Hospital. The role involves medical necessity reviews, authorizations, and coordination with the care team to ensure safe transitions of care.

Strong clinical knowledge and EPIC documentation are required. Minimum 3 years of clinical experience is required. The UM Nurse will review admissions, observations, and concurrent cases using MCG and IEF criteria to determine appropriate level of care