Utilization Management Lead

Wellstar Health System; Roswell (GA); On-site; USD 90,000 - 130,000; Full time

Job summary

Wellstar Health System is seeking a leader to manage the Utilization Management program, ensuring standards of practice and CMS/payer compliance. The role requires coordinating with physicians and hospital departments to optimize patient care and to guide program quality and throughput.

The position emphasizes education development, performance tracking, and fiscal oversight within a multidisciplinary team, contributing to Wellstar’s mission of compassionate care.

Qualifications

• Strong communication and interpersonal skills.
• Ability to multitask in a fast-paced environment.
• RN licensure required; nursing degree preferred.

Responsibilities

• Lead and manage the Utilization Management program operations.
• Ensure CMS and payer regulatory compliance across the program.
• Collaborate with physicians and hospital departments to optimize patient care.
• Develop education materials and track performance metrics.
• Coordinate budgeting and staffing for the program.

Skills

Strong communication and interpersonal

Multitask

Education

Bachelor's Nursing or Diploma (Nurse) Nursing or Masters Nursing-Preferred

Job description

Wellstar Health System is seeking a leader to manage the Utilization Management program, ensuring standards of practice and CMS/payer compliance. The role requires coordinating with physicians and hospital departments to optimize patient care and to guide program quality and throughput.

The position emphasizes education development, performance tracking, and fiscal oversight within a multidisciplinary team, contributing to Wellstar’s mission of compassionate care.