RN Utilization Review Specialist: Elevate Patient Care

Wellstar Health System, Inc.; Grovetown (GA); On-site; USD 70,000 - 85,000; Part time

Job summary

Wellstar Cobb Hospital in Georgia is seeking a Utilization Management (UM) Nurse to conduct medical necessity reviews and coordinate safe transitions of care. The role involves daily utilization reviews, collaboration with physicians, and ensuring timely authorization for admissions and hospital days.

The position requires a registered nurse with at least 3 years of clinical experience, strong case management skills, and proficiency with EPIC and MCG criteria.

Qualifications

• Active RN license in Georgia (or Compact).
• Minimum 3 years of clinical practice experience.
• Strong knowledge of case management processes.

Responsibilities

• Conduct medical necessity reviews using MCG criteria.
• Provide timely certification/authorization for hospital admissions and days.
• Perform daily utilization reviews and coordinate post-discharge care.
• Document findings accurately in EPIC and communicate with physicians.
• Collaborate with care teams to resolve payer denials.

Skills

Case management

Clinical assessment

Communication

Documentation

Team collaboration

Education

Associates Degree in Nursing

Diploma in Nursing

Bachelor's Degree in Nursing - Preferred

Tools

EPIC EMR

Indicia

IAD

IEF

MCG guidelines

Job description

Wellstar Cobb Hospital in Georgia is seeking a Utilization Management (UM) Nurse to conduct medical necessity reviews and coordinate safe transitions of care. The role involves daily utilization reviews, collaboration with physicians, and ensuring timely authorization for admissions and hospital days.

The position requires a registered nurse with at least 3 years of clinical experience, strong case management skills, and proficiency with EPIC and MCG criteria.