UM Nurse: Acute Care Utilization (Day Shift) — Sign-On

Wellstar Health System, Inc.; North Augusta (GA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Cobb Hospital in Georgia is seeking a Utilization Management Nurse who will conduct medical necessity reviews and coordinate care across units to ensure appropriate levels of care and timely discharges. You will use Indicia and EPIC documentation to support decisions and communicate with physicians and payers daily.

The role requires at least 3 years of clinical practice, strong knowledge of case management processes, and the ability to work in a fast-paced hospital setting.

Qualifications

• Graduate of an accredited school of nursing. BSN preferred.
• Strong clinical knowledge with clinical practice/experience.

Responsibilities

• Conduct medical necessity reviews up to 12 hours per day.
• Perform utilization reviews for new admissions and prebill/post-discharge accounts.
• Communicate with physicians and care teams to coordinate safe transitions of care.
• Obtain timely authorization of days from payers and document in EPIC.
• Escalate issues per chain of command and support performance improvement.

Skills

Nursing

Case Management

Communication

Education

BSN

Tools

EPIC

MCG Criteria

Job description

Wellstar Cobb Hospital in Georgia is seeking a Utilization Management Nurse who will conduct medical necessity reviews and coordinate care across units to ensure appropriate levels of care and timely discharges. You will use Indicia and EPIC documentation to support decisions and communicate with physicians and payers daily.

The role requires at least 3 years of clinical practice, strong knowledge of case management processes, and the ability to work in a fast-paced hospital setting.