Utilization Management Leader

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

Job summary

Wellstar Health System seeks a leader to oversee the Utilization Management program, implementing standards and guidelines while ensuring CMS and payer compliance to uphold high quality patient care. You will collaborate with physicians and hospital departments to drive optimal outcomes and throughput.

The role also focuses on financial performance, staff engagement, data reporting, and coordinating UM activities across the care continuum to support system goals.

Qualifications

• Bachelor’s Nursing or Diploma Nursing; Masters Nursing preferred.
• RN license required within the state or compact license.
• Minimum 3 years of experience in managing multidisciplinary staff in a hospital setting.

Responsibilities

• Provide leadership and manage all processes within the Utilization Management program.
• Ensure compliance with CMS and payer requirements and maintain quality of patient care.
• Collaborate with physicians and hospital departments to optimize program outcomes and throughput.
• Develop/maintain education materials and act as a clinical resource for UM staff.
• Monitor performance metrics, budget, and staffing to achieve program goals.

Skills

Strong communication

Multitasking

Interpersonal skills

Education

Bachelor’s in Nursing

Nursing Diploma

Master’s in Nursing (preferred)

Job description

Wellstar Health System seeks a leader to oversee the Utilization Management program, implementing standards and guidelines while ensuring CMS and payer compliance to uphold high quality patient care. You will collaborate with physicians and hospital departments to drive optimal outcomes and throughput.

The role also focuses on financial performance, staff engagement, data reporting, and coordinating UM activities across the care continuum to support system goals.