Utilization Management Nurse - PRN Days (Hospital)

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

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator (PRN Days) to support hospital admissions and ongoing care decisions.

The role emphasizes medical necessity reviews, coordination with payers, and timely authorization management across inpatient and observation cases. The UM Nurse collaborates with physicians, care teams, and payers to ensure appropriate levels of care and efficient transitions, including post-discharge and prebill processes.

Qualifications

• Minimum 3 years of clinical experience in utilization management or related field.

Responsibilities

• Conduct medical necessity reviews 24/7 using established criteria (e.g., MCG).
• Coordinate with payers and care teams to obtain timely authorizations.
• Obtain and document authorizations for all hospital days in EPIC.
• Monitor post-discharge/prebill accounts to resolve missing authorization numbers and variances.
• Communicate with providers and payers to resolve discrepancies and support appropriate level of care.

Skills

Clinical knowledge

Job description

Wellstar Health System, Inc. is seeking a Utilization Management Nurse (UM) Coordinator (PRN Days) to support hospital admissions and ongoing care decisions.

The role emphasizes medical necessity reviews, coordination with payers, and timely authorization management across inpatient and observation cases. The UM Nurse collaborates with physicians, care teams, and payers to ensure appropriate levels of care and efficient transitions, including post-discharge and prebill processes.