Utilization Management Nurse

Health Wealth Safe, Inc.; Marietta (GA); On-site; USD 85,000 - 100,000; Full time

Job summary

Health Wealth Safe, Inc. seeks an on-site Utilization Management Registered Nurse in Marietta, GA. Review patient records and care plans to determine medical necessity, patient classification, and the appropriate level of care.

You will collaborate with physicians and interdisciplinary teams to support care progression, apply criteria for placement, monitor Medicare/Medicaid guidelines, document accurately to prevent denials, and escalate concerns with findings.

Qualifications

• Active RN licensure and strong clinical judgment.
• Experience with utilization management, medical necessity review, and level-of-care determinations.
• Knowledge of payer requirements and Medicare/Medicaid documentation standards.
• Effective communication and collaboration across care teams.
• Detail-oriented documentation and compliance-focused mindset.

Responsibilities

• Collaborate with physicians and interdisciplinary teams to support care progression and continuity.
• Apply utilization and screening criteria to ensure appropriate placement and services.
• Monitor payer guidelines and Medicare/Medicaid compliance.
• Prepare and maintain timely, accurate documentation to help prevent denials.
• Escalate concerns and communicate findings to relevant stakeholders.

Skills

RN licensure

Clinical judgment

Communication

Collaboration

Documentation

Job description

Utilization Management Registered Nurse

On-site role responsible for reviewing patient records and care plans to determine medical necessity, patient classification, and the appropriate level of care.

• Collaborate with physicians and interdisciplinary teams to support care progression and continuity.


• Apply utilization and screening criteria to ensure appropriate placement and services.


• Monitor payer guidelines and Medicare/Medicaid compliance.


• Prepare and maintain timely, accurate documentation to help prevent denials.


• Escalate concerns and communicate findings to relevant stakeholders.

Qualifications & Skills

• Active RN licensure and strong clinical judgment.


• Experience with utilization management, medical necessity review, and level-of-care determinations.


• Knowledge of payer requirements and Medicare/Medicaid documentation standards.


• Effective communication and collaboration across care teams.


• Detail-oriented documentation and compliance-focused mindset.