Utilization Management RN – Acute Care (Day Shift) - Sign-On

Wellstar Health System, Inc.; Blythe (GA); On-site; USD 90,000 - 115,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management Nurse for the Cobb Hospital in Georgia. This full-time, day-shift, onsite role focuses on medical necessity reviews up to 12 hours per day across seven days, using Indicia tools for case management and coordination with the care team to ensure safe transitions of care.

Minimum 3 years of strong clinical knowledge and experience are required. A sign-on bonus and relocation assistance are available for eligible candidates.

Qualifications

• Knowledge of Case Management process.
• Excellent verbal and written communication skills.
• Strong organizational skills.
• Ability to build strong and trusting relationships with physicians and the multidisciplinary team.
• Knowledgeable with utilizing screening criteria in review of clinical data and identifying variance.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services by applying established screening criteria.
• Ensures timely certification/authorization of hospital admissions and hospital days.
• Provides required information to payors in a timely fashion and obtains appropriate authorization for all days.
• Maintains accurate documentation in EPIC and communicates with payors and physicians as needed.
• Monitors and evaluates patient plans of care and conducts timely concurrent reviews.
• Escalates issues through the established chain of command and supports continuous performance improvement initiatives.

Skills

Case Management knowledge

Verbal communication

Written communication

Organizational skills

Education

BSN degree

Job description

Wellstar Health System, Inc. is seeking a Utilization Management Nurse for the Cobb Hospital in Georgia. This full-time, day-shift, onsite role focuses on medical necessity reviews up to 12 hours per day across seven days, using Indicia tools for case management and coordination with the care team to ensure safe transitions of care.

Minimum 3 years of strong clinical knowledge and experience are required. A sign-on bonus and relocation assistance are available for eligible candidates.