Utilization Management Leader – Healthcare Operations

Wellstar Health System; Kennesaw (GA); On-site; USD 120,000 - 170,000; Full time

Job summary

Wellstar Health System in Georgia is seeking a leader to oversee the Utilization Management program, implementing standards of practice, CMS and payer guidelines, and ensuring high-quality patient care while maintaining compliance. You will drive performance, coordinate with physicians and hospital departments, and foster staff engagement.

You will manage education, data reporting, budgeting, and regulatory compliance, serving on committees and advancing cost-effective care through case

Qualifications

• Must hold RN license and nursing degree or diploma.
• 3+ years in case management leadership in a hospital setting.
• All required certifications must be current at hire.

Responsibilities

• Lead Utilization Management program and ensure CMS/commercial payer compliance and optimal patient outcomes.
• Oversee staff, budgets, and cross-department collaboration to support quality care.
• Engage with physicians, discharge planners, and regulatory bodies to maintain program standards and reporting.

Skills

Communication skills

Interpersonal skills

Multitasking

Education

Bachelor's Nursing or Diploma

Masters Nursing

Job description

Wellstar Health System in Georgia is seeking a leader to oversee the Utilization Management program, implementing standards of practice, CMS and payer guidelines, and ensuring high-quality patient care while maintaining compliance. You will drive performance, coordinate with physicians and hospital departments, and foster staff engagement.

You will manage education, data reporting, budgeting, and regulatory compliance, serving on committees and advancing cost-effective care through case