Utilization Management Leader - RN Case Management

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

Job summary

Wellstar Health System is seeking a seasoned leader to head the Utilization Management program, ensuring high-quality patient care and regulatory compliance. You will drive the implementation of standards, guidelines, and performance metrics across the department.

You will collaborate with physicians, hospital leadership, and payers to optimize outcomes, throughput, and cost-effective care while fostering staff development and engagement.

Qualifications

• Bachelor's Nursing degree or Nursing diploma; Master's preferred.
• RN licensure in a single state or Compact license.
• Minimum 3 years of management of multidisciplinary staff in case management.

Responsibilities

• Lead Utilization Management while ensuring CMS and payer compliance.
• Coordinate program functions with physicians and hospital departments.
• Oversee budget, staff engagement, and performance metrics.
• Represent Wellstar in committees and regulatory bodies.

Skills

Strong communication

Interpersonal skills

Multitasking

Education

Bachelor's in Nursing

Nursing Diploma

Masters in Nursing (Preferred)

Job description

Wellstar Health System is seeking a seasoned leader to head the Utilization Management program, ensuring high-quality patient care and regulatory compliance. You will drive the implementation of standards, guidelines, and performance metrics across the department.

You will collaborate with physicians, hospital leadership, and payers to optimize outcomes, throughput, and cost-effective care while fostering staff development and engagement.