Utilization Management Nurse - PRN Days

Wellstar Health System, Inc.; Greenfield (SC); On-site; USD 85,000 - 105,000; Full time

Job summary

Wellstar Health System, Cobb Hospital is seeking a Utilization Management Nurse (UM) Coordinator for a PRN Days role. Strong clinical knowledge and experience in medical necessity reviews, payer communications and care coordination are essential.

The UM will review admissions, observe cases and concurrent reviews, using mcg Indicia, and ensure timely authorizations across units. EPIC documentation and collaboration with physicians are critical.

Qualifications

• Minimum 3 years of strong clinical knowledge with clinical practice/experience.

Responsibilities

• Conduct medical necessity reviews 24/7 using established criteria.
• Obtain timely authorizations and document in EPIC.
• Coordinate post-discharge reviews and ALOS vs authorized days.
• Communicate with payers and care team to ensure appropriate level of care.
• Escalate denials and collaborate with physicians and managed care.

Skills

Clinical knowledge

MCG/Indicia

EPIC usage

Tools

EPIC

mcg Indicia

Job description

Wellstar Health System, Cobb Hospital is seeking a Utilization Management Nurse (UM) Coordinator for a PRN Days role. Strong clinical knowledge and experience in medical necessity reviews, payer communications and care coordination are essential.

The UM will review admissions, observe cases and concurrent reviews, using mcg Indicia, and ensure timely authorizations across units. EPIC documentation and collaboration with physicians are critical.