Utilization Management Nurse (UM) Coordinator - PRN

Wellstar Health System; Austell (GA); On-site; USD 90,000 - 110,000; Full time

Job summary

Wellstar Health System's Cobb Hospital is seeking an experienced Utilization Management Nurse (UM) Coordinator for a PRN role. You will conduct medical necessity reviews 24/7 using MCG Indicia, coordinate with physicians, payers, and care teams to ensure appropriate levels of care and timely authorizations in EPIC.

Responsibilities include post-discharge/post-bill follow-ups, documentation, and participating in performance improvement initiatives while complying with payer regulations.

Qualifications

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

Responsibilities

• Initiates assessment for necessity and appropriateness of health services by the application of established screening criteria (e.g. MCG).
• Ensures timely certification/authorization of hospital admissions and hospital days with payors.
• Monitors and evaluates ongoing plan of care and conducts timely concurrent reviews.
• Communicates with providers, payers and care team to facilitate appropriate level of care.
• Completes chart notes accurately and documents all reviews and updates in EPIC.

Skills

Clinical knowledge

Utilization review

Care coordination

Documentation

Tools

EPIC

MCG Indicia

Job description

Wellstar Health System's Cobb Hospital is seeking an experienced Utilization Management Nurse (UM) Coordinator for a PRN role. You will conduct medical necessity reviews 24/7 using MCG Indicia, coordinate with physicians, payers, and care teams to ensure appropriate levels of care and timely authorizations in EPIC.

Responsibilities include post-discharge/post-bill follow-ups, documentation, and participating in performance improvement initiatives while complying with payer regulations.