RN Utilization Review Leader: Clinical Excellence

Northeast Georgia Medical Center; United States; On-site; USD 90,000 - 130,000; Full time

Job summary

Northeast Georgia Health System seeks a Nursing - Registered Nurse to supervise the Utilization Review Department, ensuring effective clinical utilization reviews, precertification, denial analysis, and related revenue activities. Collaboration with Case Management and Revenue Cycle leaders supports safe patient care and compliant service delivery.

Ideal candidates will have an RN license in GA, an Associate degree, and UR/Case Management experience, plus strong communication and leadership

Qualifications

• GA RN license (current)
• Associate degree required
• Experience in Utilization Management or Case Management; knowledge of healthcare regulations

Responsibilities

• Supervise day-to-day UR operations including precertification and reviews
• Serve as clinical resource for UR policies and government programs
• Develop/update UR policies to improve reimbursement and care quality
• Recruit, onboard and train UR staff; monitor performance against KPIs
• Collaborate with Case Management and other departments to ensure seamless care and compliance

Skills

Communication

Supervisory experience

Organizational skills

Attention to detail

Education

Associate degree

Bachelor's degree (preferred)

Tools

MS Office

Excel

Word

Job description

Northeast Georgia Health System seeks a Nursing - Registered Nurse to supervise the Utilization Review Department, ensuring effective clinical utilization reviews, precertification, denial analysis, and related revenue activities. Collaboration with Case Management and Revenue Cycle leaders supports safe patient care and compliant service delivery.

Ideal candidates will have an RN license in GA, an Associate degree, and UR/Case Management experience, plus strong communication and leadership