Utilization Management Nurse – Hospital-Based Sign-On Bonus

Wellstar Health System, Inc.; United States; Presencial; USD 80.000 - 105.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Sign-on bonus

Relocation assistance

Descripción de la vacante

The Utilization Management (UM) Nurse at Wellstar Cobb Hospital is responsible for medical necessity reviews and concurrent utilization management across units, using MCG criteria and Indicia tools to determine the appropriate level of care. You will collaborate with physicians, care teams and payers to ensure timely authorization and discharge planning.

Requires a BSN, RN license and at least 3 years of clinical practice.

Formación

• Requires BSN degree and active RN license in the US.
• Minimum 3 years of clinical experience in nursing relevant to utilization management.
• Proficient in applying screening criteria (MCG) and collaborating with physicians and payers.

Responsabilidades

• Initiates assessment for necessity and appropriateness of health services using established criteria (e.g., MCG).
• Ensures timely certification/authorization of hospital admissions and days; documents authorizations in EPIC.
• Monitors ongoing plan of care, conducts concurrent reviews, and communicates with payers to resolve discrepancies.

Conocimientos

Case management

Clinical documentation

Interdisciplinary collaboration

EPIC software

Educación

BSN degree in nursing

RN license (US)

Herramientas

EPIC

Indicia

Descripción del empleo

The Utilization Management (UM) Nurse at Wellstar Cobb Hospital is responsible for medical necessity reviews and concurrent utilization management across units, using MCG criteria and Indicia tools to determine the appropriate level of care. You will collaborate with physicians, care teams and payers to ensure timely authorization and discharge planning.

Requires a BSN, RN license and at least 3 years of clinical practice.