Utilization Management RN - Acute Care, Day Shifts

Wellstar Health System, Inc.; Greenfield (SC); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Health System is seeking a Utilization Management (UM) Nurse for Cobb Hospital. This full-time, day-shift role conducts medical necessity reviews up to 12 hours daily, using Indicia criteria, coordinating with physicians and the care team to assure safe transitions of care.

The UM nurse documents in EPIC and works with payers to obtain timely authorizations. Minimum 3 years of clinical practice experience is required.

Qualifications

• Must have strong clinical knowledge and clinical practice/experience.
• Experience with case management processes and documentation.
• Excellent verbal and written communication skills.
• Strong organizational skills and ability to collaborate with physicians and care team.

Responsibilities

• Conduct medical necessity reviews using established criteria (MCG).
• Coordinate with care team for safe transitions of care.
• Obtain timely authorization and document in EPIC for days and approved durations.
• Communicate with payers and physicians to resolve denials and discrepancies.

Skills

Case management knowledge

Verbal communication

Written communication

Organizational skills

Critical thinking

Education

Bachelor's degree in nursing (BSN)

RN license (single state)

Job description

Wellstar Health System is seeking a Utilization Management (UM) Nurse for Cobb Hospital. This full-time, day-shift role conducts medical necessity reviews up to 12 hours daily, using Indicia criteria, coordinating with physicians and the care team to assure safe transitions of care.

The UM nurse documents in EPIC and works with payers to obtain timely authorizations. Minimum 3 years of clinical practice experience is required.