Utilization Management RN Coordinator | PRN

2510 Cobb Hospital, Inc.; United States; Sur place; USD 70 000 - 100 000; Temps partiel

Résumé du poste

The Utilization Management Nurse (UM) Coordinator at Wellstar Cobb Hospital conducts medical necessity reviews around the clock to support safe transitions of care. Using MCG criteria and EPIC, the UM nurse communicates with payers and care teams to secure timely authorizations for hospital admissions and days.

Support is provided across multiple units with a focus on reducing delays, monitoring ALOS, and ensuring accurate documentation and escalation when denials occur.

Qualifications

• Strong clinical knowledge and experience in clinical practice.
• Excellent verbal and written communication skills.
• Highly organized with attention to detail and timeliness.
• Knowledge of Case Management processes and guidelines like MCG.

Responsabilités

• Perform daily utilization reviews to determine appropriate level of care using established criteria (e.g., MCG).
• Obtain timely hospital certifications/authorizations and document in EPIC.
• Communicate with payers, physicians, and care team to coordinate care and authorizations.
• Monitor post-discharge activity and resolve authorization or days variances to prevent denials.

Connaissances

Clinical knowledge

Communication skills

Organizational skills

Case management knowledge

Formation

Associates Nursing or Diploma

RN license required

Outils

EPIC EMR

Description du poste

The Utilization Management Nurse (UM) Coordinator at Wellstar Cobb Hospital conducts medical necessity reviews around the clock to support safe transitions of care. Using MCG criteria and EPIC, the UM nurse communicates with payers and care teams to secure timely authorizations for hospital admissions and days.

Support is provided across multiple units with a focus on reducing delays, monitoring ALOS, and ensuring accurate documentation and escalation when denials occur.