UM RN: Drive Appropriate Care & Timely Discharges

Wellstar Health System, Inc.; Roswell (GA); On-site; USD 70,000 - 110,000; Full time

Job summary

The Wellstar Health System in Georgia is seeking an experienced Utilization Management (UM) Nurse to conduct medical necessity reviews and coordinate safe transitions of care. This role utilizes MCG criteria and EPIC documentation to ensure optimal patient placement and timely authorizations.

Responsibilities include daily reviews of admissions, observation cases, and post-discharge activities, collaborating with physicians and payers, and supporting continuous improvement in care quality and

Qualifications

• Associates degree in Nursing or Nursing Diploma, or Bachelor’s in Nursing preferred.
• RN license (Single State) or RN-COMPACT (multi-state).
• BLS certification or equivalent.

Responsibilities

• Utilization Management to assess necessity and appropriateness of health services (MCG criteria).
• Initiates assessment for necessity and appropriateness of health services.
• Ensures timely certification/authorization of hospital admissions and days.
• Documents reviews and authorizations in EPIC and communicates with payers.
• Monitors post-discharge/prebill accounts for discrepancies and collaborates with care teams.

Education

Associates Degree in Nursing or Nursing Diploma, or Bachelor’s in Nursing (preferred)

Job description

The Wellstar Health System in Georgia is seeking an experienced Utilization Management (UM) Nurse to conduct medical necessity reviews and coordinate safe transitions of care. This role utilizes MCG criteria and EPIC documentation to ensure optimal patient placement and timely authorizations.

Responsibilities include daily reviews of admissions, observation cases, and post-discharge activities, collaborating with physicians and payers, and supporting continuous improvement in care quality and