Utilization Management Nurse Leader

Wellstar Health System; Martinez (GA); On-site; USD 110,000 - 160,000; Full time

Job summary

Wellstar Health System is seeking a dynamic leader for the Utilization Management program, responsible for guiding care guidelines, regulatory compliance, and cross-department collaboration. The role focuses on ensuring quality patient outcomes, optimal throughput, and financial stewardship within a large health system.

The candidate will drive staff engagement, participate in CMS/commercial payer initiatives, and coordinate with physicians and hospital leadership to maintain program excellence

Qualifications

• Bachelor’s or Master’s degree in healthcare administration or related field.
• Proven leadership experience in utilization management or case management.
• Strong knowledge of CMS guidelines and payer compliance.
• Experience coordinating hospital-wide programs and interdepartmental teams.
• Ability to analyze data and inform process improvements.

Responsibilities

• Provide leadership and manage all processes within the Utilization Management program.
• Ensure adherence to evidence-based guidelines, policies, and CMS/payer compliance.
• Oversee financial performance, HR management, and staff engagement.
• Coordinate with physicians and hospital departments to optimize outcomes.
• Lead committee participation and drive program quality and throughput.
• Monitor utilization review standards and reporting, and ensure regulatory compliance.

Skills

Leadership

Utilization Management

CMS compliance

Program management

Interdepartmental collaboration

Staff engagement

Communication

Education

Bachelor's degree in Healthcare Administration

Master's degree in Healthcare Administration

Tools

EMR systems

Healthcare analytics software

Job description

Wellstar Health System is seeking a dynamic leader for the Utilization Management program, responsible for guiding care guidelines, regulatory compliance, and cross-department collaboration. The role focuses on ensuring quality patient outcomes, optimal throughput, and financial stewardship within a large health system.

The candidate will drive staff engagement, participate in CMS/commercial payer initiatives, and coordinate with physicians and hospital leadership to maintain program excellence