Utilization Management Nurse: Impactful Patient Care Leader

Wellstar Health System; Marietta (GA); On-site; USD 80,000 - 100,000; Full time

Job summary

Wellstar Health System in Georgia seeks a Utilization Management (UM) Nurse to perform medical necessity reviews up to 12 hours daily, seven days a week, using MCG criteria and Indicia tools. You will collaborate with physicians and the care team to coordinate safe transitions of care and ensure accurate documentation in EPIC for timely billing.

This role emphasizes ongoing chart reviews, post-discharge assessments, and adherence to payer regulations.

Qualifications

• Associates degree or nursing diploma; BSN preferred.
• RN license required (single-state or compact).
• Minimum 3 years of strong clinical knowledge and experience.
• Experience with Case Management processes and EPIC documentation.

Responsibilities

• Conduct medical necessity reviews using MCG criteria and agency guidelines.
• Ensure timely certification/authorization of hospital admissions and days; document in EPIC.
• Collaborate with physicians and care teams to coordinate transitions of care.
• Perform daily utilization reviews for new admissions, observation cases, and concurrent reviews.
• Escalate issues per policy and contribute to process improvements.

Skills

Case Management

Communication

Organization

Clinical Judgment

Physician Collaboration

Education

Associate Degree in Nursing

BSN Preferred

Tools

EPIC

Job description

Wellstar Health System in Georgia seeks a Utilization Management (UM) Nurse to perform medical necessity reviews up to 12 hours daily, seven days a week, using MCG criteria and Indicia tools. You will collaborate with physicians and the care team to coordinate safe transitions of care and ensure accurate documentation in EPIC for timely billing.

This role emphasizes ongoing chart reviews, post-discharge assessments, and adherence to payer regulations.