Utilization Management Nurse Leader

Wellstar Health System; Crestdale (SC); On-site; USD 110,000 - 180,000; Full time

Job summary

Wellstar Health System in the United States is seeking a senior leader to oversee the Utilization Management program, ensuring adherence to evidence-based guidelines, CMS requirements, and payer contracts; leads multidisciplinary teams to optimize patient care quality and throughput.

The role drives financial performance, HR management, and coordination with physicians and hospital departments; participates in UM committees, develops education materials, and ensures compliance and reporting.

Responsibilities

• Oversees the Utilization Review process from admission through discharge and follow-up.
• Maintains competency in CMS and payer standards and ensures annual reviews.
• Analyzes utilization data and reports to support performance and budgeting.
• Serves as liaison between clinical departments to align goals and optimize care.
• Promotes staff engagement, teamwork and professional development within the UM program.

Job description

Wellstar Health System in the United States is seeking a senior leader to oversee the Utilization Management program, ensuring adherence to evidence-based guidelines, CMS requirements, and payer contracts; leads multidisciplinary teams to optimize patient care quality and throughput.

The role drives financial performance, HR management, and coordination with physicians and hospital departments; participates in UM committees, develops education materials, and ensures compliance and reporting.