Utilization Management RN – Elevate Care Coordination

Wellstar Health System, Inc.; Fulton, Northern (MO, KY); Hybrid; USD 70,000 - 90,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management RN to review medical necessity, coordinate with the care team, and secure payer authorizations. This role supports safe transitions of care and requires strong clinical judgment and EPIC proficiency.

The position is part-time, day shift, with responsibilities spanning admission reviews, concurrent and post-discharge activities within the UM framework. Candidates with 3+ years of experience and an RN license are encouraged to apply.

Qualifications

• Active RN license in state (Missouri or multi-state)
• Minimum 3 years of clinical experience
• Experience with utilization management or case reviews preferred

Responsibilities

• Perform medical necessity reviews using criteria (MCG)
• Coordinate with physicians and care team
• Obtain payer authorizations and document in EPIC
• Participate in post-discharge care coordination

Skills

RN license

Case management

Clinical reviews

Communication skills

Education

Associate degree or Diploma in Nursing

Bachelor's degree in Nursing (preferred)

Tools

EPIC EMR

Job description

Wellstar Health System, Inc. is seeking a Utilization Management RN to review medical necessity, coordinate with the care team, and secure payer authorizations. This role supports safe transitions of care and requires strong clinical judgment and EPIC proficiency.

The position is part-time, day shift, with responsibilities spanning admission reviews, concurrent and post-discharge activities within the UM framework. Candidates with 3+ years of experience and an RN license are encouraged to apply.