Utilization Management RN — Care Coordination Pro

Wellstar Health Systems, Inc.; Austell (GA); On-site; USD 55,000 - 69,000; Part time

Job summary

Wellstar Health Systems, Inc. seeks a PRN Utilization Management Nurse (UM) to conduct medical necessity reviews and coordinate with payers and care teams. This on-site role at Cobb Hospital requires coordinating safe transitions of care, daily reviews, and timely authorizations.

Strong nursing background and EPIC experience are essential. The UM Nurse will document interactions, monitor ALOS, and collaborate with physicians to overturn denials when appropriate.

Qualifications

• RN license and nursing degree required.
• Strong case management and clinical documentation skills.
• Proficient computer skills and experience with EPIC and clinical tools.

Responsibilities

• Perform medical necessity reviews 24/7 and coordinate with payers.
• Document communications and authorization status in the medical record and EPIC.
• Escalate and resolve denials; collaborate with physicians and care teams.
• Assist in patient transitions and ensure timely authorizations for hospital admissions and days.

Skills

Case management knowledge

Computer skills

Physician communication

Education

RN license

Nursing degree

Tools

EPIC EHR

mcg Indicia

Job description

Wellstar Health Systems, Inc. seeks a PRN Utilization Management Nurse (UM) to conduct medical necessity reviews and coordinate with payers and care teams. This on-site role at Cobb Hospital requires coordinating safe transitions of care, daily reviews, and timely authorizations.

Strong nursing background and EPIC experience are essential. The UM Nurse will document interactions, monitor ALOS, and collaborate with physicians to overturn denials when appropriate.