Utilization Management RN - Acute Care

Wellstar Health System, Inc.; Harlem (GA); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Health System, Inc. seeks an experienced Utilization Management nurse for Cobb Hospital in Georgia. You will conduct medical necessity reviews, coordinate with physicians and care teams, and ensure timely authorization and accurate EPIC documentation.

This full-time, onsite role requires a strong background in case management and post-discharge coordination. Minimum 3 years of clinical experience and a BSN are required.

Qualifications

• Minimum 3 years of clinical practice/experience.
• Graduate of approved nursing program; BSN preferred.
• RN license (single state) or multi-state compact.
• Knowledge of Case Management and utilization review processes.

Responsibilities

• Perform medical necessity reviews using established screening criteria (e.g. MCG).
• Obtain timely authorization for hospital admissions and days.
• Document reviews and actions in EPIC.
• Coordinate safe transitions of care with the care team and physicians.
• Liaise with payers and providers to resolve denials and ensure timely billing.

Skills

Clinical knowledge

Verbal communication

Written communication

Organizational skills

Relationship building

Case Management

Analytical thinking

Education

BSN degree

Accredited nursing program

Tools

EPIC

Indicia

IAD

IEF

Job description

Wellstar Health System, Inc. seeks an experienced Utilization Management nurse for Cobb Hospital in Georgia. You will conduct medical necessity reviews, coordinate with physicians and care teams, and ensure timely authorization and accurate EPIC documentation.

This full-time, onsite role requires a strong background in case management and post-discharge coordination. Minimum 3 years of clinical experience and a BSN are required.