Utilization Management RN Coordinator - PRN

Live Well Homecare Agency, LLC; Austell (GA); On-site; USD 65,000 - 90,000; Part time

Job summary

Live Well Homecare Agency, LLC in Austell, GA is seeking an Utilization Management Nurse (UM) Coordinator to conduct 24/7 medical necessity reviews, determine appropriate levels of care, and coordinate with payers, providers, and care teams to obtain authorizations and monitor patient progress.

The role emphasizes meticulous documentation, compliance with payer and regulatory requirements, patient advocacy, and ongoing professional development within an integrated health system.

Qualifications

• Minimum 3 years of clinical practice.
• Associates or Bachelor’s Nursing degree preferred; RN license (state or multi-state) and BLS certification required.
• Strong knowledge of case management and excellent communication, organizational, and critical thinking skills.

Responsibilities

• Perform daily clinical reviews of admissions, observation cases, and concurrent care using established criteria.
• Obtain timely authorizations, document activities accurately, and communicate with payers to resolve discrepancies.
• Monitor post-discharge accounts for authorization issues, variances, and denials, escalating as needed.
• Ensure compliance with payer and regulatory requirements, advocate for patients, and support continuous improvement initiatives.
• Complete thorough documentation and participate in professional development activities.

Skills

Clinical experience

Case management knowledge

Communication skills

Organizational skills

Critical thinking

Education

RN license (state or multi-state)

BLS certification

Tools

Computer proficiency

Job description

Live Well Homecare Agency, LLC in Austell, GA is seeking an Utilization Management Nurse (UM) Coordinator to conduct 24/7 medical necessity reviews, determine appropriate levels of care, and coordinate with payers, providers, and care teams to obtain authorizations and monitor patient progress.

The role emphasizes meticulous documentation, compliance with payer and regulatory requirements, patient advocacy, and ongoing professional development within an integrated health system.