Utilization Management Nurse - PRN Days

Wellstar Health System, Inc.; Grovetown (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for PRN Day shifts at Cobb Hospital. The UM Coordinator will perform medical necessity reviews around the clock, coordinate with payers and the care team, and guide appropriate levels of care using MCg Indicia guidelines.

Strong clinical experience and EPIC documentation are essential. The role requires proactive communication with physicians, payers, and hospital staff to ensure timely authorization and

Qualifications

• 3+ years of clinical experience with strong clinical knowledge.
• Experience with utilization management and medical necessity reviews.
• Knowledge of MCg Indicia guidance.

Responsibilities

• Initiates and conducts medical necessity reviews 24/7.
• Coordinate with payers and care team for authorization and level of care.
• Ensure timely documentation of reviews and authorizations in EPIC.
• Communicate with providers and payers to resolve discrepancies.
• Support post-discharge/ prebill accounts to resolve authorization issues.

Skills

Clinical knowledge

Utilization management

MCG Indicia

Medical necessity

Tools

EPIC

Job description

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for PRN Day shifts at Cobb Hospital. The UM Coordinator will perform medical necessity reviews around the clock, coordinate with payers and the care team, and guide appropriate levels of care using MCg Indicia guidelines.

Strong clinical experience and EPIC documentation are essential. The role requires proactive communication with physicians, payers, and hospital staff to ensure timely authorization and