Utilization Management RN: Care Coordination & Reviews

Wellstar Health System, Inc.; Marietta (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse to perform medical-necessity reviews using MCG criteria across units and payers, coordinating safe transitions of care with the team.

You will document in EPIC, obtain timely authorizations, monitor ALOS vs authorized days, and support continuous performance improvement while complying with payer regulations. This role offers exposure to a comprehensive care network in Georgia.

Qualifications

• Assess health services necessity using established screening criteria (e.g. MCG).
• Identify insurance requirements for all payers and ensure adherence.
• Documentation and post-discharge review activities including accurate chart notes and EPIC entries.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services using established screening criteria (e.g. MCG).
• Assesses insurance and coverage requirements for all payers and ensures adherence at all times.
• Documentation and post-discharge work including chart notes and timely updates in EPIC; supports continuity of care.

Skills

Case Management

Verbal & written communication

Organizational skills

Relationship building with physicians

Screening criteria

Critical thinking

Computer skills

Education

Nursing degree

Job description

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse to perform medical-necessity reviews using MCG criteria across units and payers, coordinating safe transitions of care with the team.

You will document in EPIC, obtain timely authorizations, monitor ALOS vs authorized days, and support continuous performance improvement while complying with payer regulations. This role offers exposure to a comprehensive care network in Georgia.