Utilization Management Leader - RN Case Management

Wellstar Health System; Sandy Springs (GA); On-site; USD 120,000 - 180,000; Full time

Job summary

Wellstar Health System seeks a dynamic leader to direct the Utilization Management program, implementing evidence-based guidelines, CMS and payer standards, and high-quality patient care across the hospital.

The role oversees program operations, budgeting, staff engagement, and cross-disciplinary collaboration with physicians and other departments to optimize outcomes and patient throughput while maintaining regulatory compliance.

Qualifications

• RN license required; current state licensure.
• Minimum 3 years in hospital case management or related leadership.
• Experience leading multidisciplinary staff and coordinating with clinical teams.

Responsibilities

• Lead the Utilization Management program and ensure CMS/commercial payer compliance.
• Coordinate with physicians and hospital departments to optimize patient care and throughput.
• Oversee program operations, budgeting, and staff engagement to meet performance goals.
• Develop and sustain education materials and outcome metrics for benchmarking.

Skills

Communication

Interpersonal skills

Multitasking

Education

Bachelor's degree in Nursing

Diploma in Nursing

Masters in Nursing (Preferred)

Job description

Wellstar Health System seeks a dynamic leader to direct the Utilization Management program, implementing evidence-based guidelines, CMS and payer standards, and high-quality patient care across the hospital.

The role oversees program operations, budgeting, staff engagement, and cross-disciplinary collaboration with physicians and other departments to optimize outcomes and patient throughput while maintaining regulatory compliance.