RN Utilization Management Lead - Real-Time Care

2310 AU Medical Center, Inc.; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Wellstar Health System is seeking an On-site Utilization Management Nurse Team Lead. You will oversee UM RNs, coordinate care across acute to long-term illness, and ensure medical necessity determinations.

This role requires RN licensure, minimum 3 years clinical experience, and 1–2 years in UM/care coordination; you will train staff, manage Epic UR screens, and ensure compliance with Medicare/Medicaid.

Qualifications

• Minimum 3 years of clinical nursing experience.
• 1–2 years UM/care coordination experience required.
• Knowledge of Case Management processes and screening criteria.
• Strong organizational and communication skills.
• Proven ability to lead and train staff.

Responsibilities

• Oversee On-site UM staff and coordinate daily workflow.
• Mentor and train staff; participate in interviewing.
• Apply criteria (MCG) for medical necessity and appropriate level of care.
• Collaborate with physicians and provider liaison; ensure documentation.
• Ensure compliance with Medicare/Medicaid and billing requirements.

Skills

Clinical knowledge

UM/Case management

Coordination

Communication

Leadership

Education

Diploma in Nursing

Associate Degree in Nursing

Bachelor of Science in Nursing

Tools

Epic

EMR

Job description

Wellstar Health System is seeking an On-site Utilization Management Nurse Team Lead. You will oversee UM RNs, coordinate care across acute to long-term illness, and ensure medical necessity determinations.

This role requires RN licensure, minimum 3 years clinical experience, and 1–2 years in UM/care coordination; you will train staff, manage Epic UR screens, and ensure compliance with Medicare/Medicaid.