Utilization Management RN — Clinical Navigator (Onsite, Day)

Wellstar Health System; Austell (GA); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Health System is seeking a Utilization Management (UM) Nurse at Cobb Hospital in Georgia. The role focuses on conducting medical necessity reviews, coordinating with physicians, and ensuring timely authorization and documentation in EPIC.

This full-time, day-shift on-site position requires a minimum of 3 years of clinical experience and strong knowledge of case management. Sign-on bonus and relocation assistance are available for eligible candidates.

Qualifications

• Knowledge of Case Management process.
• Excellent verbal and written communication skills.
• Strong organizational skills.
• Ability to build strong relationships with physicians and the care team.
• Knowledge of screening criteria in review of clinical data.
• Ability to think critically and influence throughput.

Responsibilities

• Conduct medical necessity reviews using Indicia criteria.
• Collaborate with physicians and care team for safe transitions of care.
• Obtain authorizations and document in EPIC.
• Monitor post-discharge/prebill accounts for authorization and discrepancies.
• Communicate with payers to resolve discrepancies and escalate as needed.
• Document reviews and actions per policy and procedures.

Skills

Case Management

Verbal communication

Written communication

Organizational skills

Interdisciplinary collaboration

Critical thinking

Education

BSN (preferred)

Registered Nurse license

Job description

Wellstar Health System is seeking a Utilization Management (UM) Nurse at Cobb Hospital in Georgia. The role focuses on conducting medical necessity reviews, coordinating with physicians, and ensuring timely authorization and documentation in EPIC.

This full-time, day-shift on-site position requires a minimum of 3 years of clinical experience and strong knowledge of case management. Sign-on bonus and relocation assistance are available for eligible candidates.