RN Utilization Review Nurse – Impactful Care Coordination

Wellstar Health System, Inc.; Hephzibah (GA); On-site; USD 55,000 - 74,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for a part-time weekend role at Cobb Hospital.

You will conduct medical necessity reviews up to 12 hours daily, utilizing Indicia and EPIC for documentation, and collaborate with physicians and the care team to coordinate safe transitions of care. The role requires at least 3 years of strong clinical knowledge, RN licensure, and experience with case management.

Qualifications

• Required: RN license and strong clinical knowledge with 3+ years of experience.
• Experience with case management and utilization review processes.
• Proficient in EPIC, documentation, and communication with physicians.

Responsibilities

• Perform daily utilization reviews using established criteria to determine level of care.
• Obtain timely authorizations and document in EPIC.
• Collaborate with care teams to coordinate safe transitions of care.
• Communicate with payers to resolve discrepancies and maintain compliant records.

Skills

RN licensure

Communication

Organizational skills

Relationship building with physicians

Case management knowledge

Critical thinking

Computer skills

Education

Associates or Diploma in Nursing

Bachelor's in Nursing preferred

Tools

EPIC

MCG Indicia

IAD/IEF documentation

Job description

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for a part-time weekend role at Cobb Hospital.

You will conduct medical necessity reviews up to 12 hours daily, utilizing Indicia and EPIC for documentation, and collaborate with physicians and the care team to coordinate safe transitions of care. The role requires at least 3 years of strong clinical knowledge, RN licensure, and experience with case management.