Senior Utilization Management Lead

Wellstar Health System; Marietta (GA); On-site; USD 110,000 - 140,000; Full time

Job summary

Wellstar Health System in Marietta, GA is seeking a leader to direct the Utilization Management program. You will implement standards, guide quality of patient care, and ensure CMS/commercial payer compliance while coordinating with physicians and hospital departments.

The role focuses on program operations, financial performance, and staff engagement, with emphasis on data-driven improvements and cross-functional collaboration to optimize outcomes and throughput.

Qualifications

• RN license required and current.
• Experience in case management, preferably in hospital settings.
• Minimum 3 years of management of a multidisciplinary staff.

Responsibilities

• Lead Utilization Management program and ensure compliance with CMS and payer standards.
• Oversee daily operations, budgeting and staff engagement to meet goals.
• Collaborate with physicians and hospital departments to optimize patient care and throughput.
• Develop and monitor outcome scorecards and report performance metrics.
• Coordinate authorizations with MD offices during admissions and treatment plans.

Skills

Communication skills

Interpersonal skills

Education

BSN or Diploma in Nursing

MSN preferred

Job description

Wellstar Health System in Marietta, GA is seeking a leader to direct the Utilization Management program. You will implement standards, guide quality of patient care, and ensure CMS/commercial payer compliance while coordinating with physicians and hospital departments.

The role focuses on program operations, financial performance, and staff engagement, with emphasis on data-driven improvements and cross-functional collaboration to optimize outcomes and throughput.