Utilization Management RN - Acute Care (Sign-On Bonus)

Wellstar Health Systems, Inc.; Richmond (VA); On-site; USD 90,000 - 105,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

The Utilization Management (UM) Nurse at Cobb Hospital conducts medical necessity reviews and collaborates with physicians to ensure safe transitions of care. Duties include reviewing admissions, observation cases, and concurrent reviews using Indicia criteria, documenting in EPIC, and communicating with payors.

Requirements include a BSN, RN license, and a minimum of three years of clinical experience; strong case management knowledge and excellent communication are essential.

Qualifications

• RN with BSN, licensed in the relevant state.
• Minimum 3 years of strong clinical nursing experience.
• Experience with case management and utilization review is preferred.

Responsibilities

• Assessment: apply screening criteria to determine necessity and appropriateness of health services.
• Utilization Management: certify/authorize hospital admissions and days in EPIC; coordinate with payors.
• Documentation & Post Discharge: timely chart notes and updates; resolve post-discharge discrepancies.
• Professional Development: complete competency assessments and serve as preceptor/mentor.
• Join us to do meaningful work with support and opportunities.

Skills

Knowledge of Case Management process

Excellent verbal and written comms

Strong organizational skills

Relationship building with physicians

Screening criteria knowledge in data

Critical thinking and analysis

Strong computer skills

Education

BSN degree

Job description

The Utilization Management (UM) Nurse at Cobb Hospital conducts medical necessity reviews and collaborates with physicians to ensure safe transitions of care. Duties include reviewing admissions, observation cases, and concurrent reviews using Indicia criteria, documenting in EPIC, and communicating with payors.

Requirements include a BSN, RN license, and a minimum of three years of clinical experience; strong case management knowledge and excellent communication are essential.