Utilization Management RN: Case & Payer Reviews

Wellstar Health System, Inc.; Marietta (GA); On-site; USD 75,000 - 105,000; Full time

Job summary

Wellstar Health System, Inc. in Georgia is seeking an Utilization Management Nurse to conduct medical necessity reviews and determine the appropriate level of care across units.

You will use established criteria (MCG) and EPIC for timely authorization and accurate documentation, supporting high-quality patient care. Collaborating with physicians and the care team, you will coordinate transitions and ensure compliance with payer regulations while contributing to continuous performance improvement

Qualifications

• Bachelor's degree in Nursing or diploma required; RN licensure.
• Minimum 3 years of clinical experience in hospital settings.
• Experience with utilization review and case management processes.
• Strong communication and documentation skills.

Responsibilities

• Perform daily utilization reviews and determine appropriate level of care.
• Coordinate with physicians and care team for safe transitions.
• Complete and document chart notes and post-discharge information.
• Ensure timely authorizations and accurate EPIC documentation.

Skills

Case Management

Communication

Organizational Skills

Clinical Review

Education

Associates Nursing or Diploma (Nurse)

Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System, Inc. in Georgia is seeking an Utilization Management Nurse to conduct medical necessity reviews and determine the appropriate level of care across units.

You will use established criteria (MCG) and EPIC for timely authorization and accurate documentation, supporting high-quality patient care. Collaborating with physicians and the care team, you will coordinate transitions and ensure compliance with payer regulations while contributing to continuous performance improvement