Utilization Management Nurse - PRN Days

Wellstar Health System, Inc.; Martinez (GA); On-site; USD 85,000 - 105,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for PRN daytime coverage at Cobb Medical Center. The role focuses on medical necessity reviews, care coordination, and payer communications to ensure safe transitions of care.

Strong clinical knowledge and experience with EPIC are essential. The UM Nurse will perform daily reviews, obtain authorizations, and document activities to support timely billing and appropriate levels of care across the patient

Qualifications

• Minimum 3 years of clinical experience with strong clinical knowledge.
• Experience performing medical necessity reviews and utilization management.
• Knowledge of EPIC and payer communication processes.

Responsibilities

• Conduct medical necessity reviews 24/7 using established criteria (e.g. MCG).
• Coordinate with payers and care teams to obtain authorizations and ensure documentation in EPIC.
• Perform daily utilization reviews for new admissions, observations, and concurrent cases.
• Communicate with providers and etc. to facilitate care and treatment
• Obtain timely authorization of all ALOS days from payers and ensure documentation.
• Track avoidable days and ensure accurate charting and escalation as needed.

Skills

Strong clinical knowledge

Tools

EPIC

MCG Indicia

Job description

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator for PRN daytime coverage at Cobb Medical Center. The role focuses on medical necessity reviews, care coordination, and payer communications to ensure safe transitions of care.

Strong clinical knowledge and experience with EPIC are essential. The UM Nurse will perform daily reviews, obtain authorizations, and document activities to support timely billing and appropriate levels of care across the patient