Utilization Management RN — Impactful Care & Approvals

Wellstar Health System; Roswell (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

Wellstar Health System is seeking a Utilization Management Nurse to review medical necessity for admissions and ongoing care across 7 days per week, using Indicia criteria and EPIC documentation. The role collaborates with physicians and care teams to ensure appropriate levels of care and timely discharge planning.

Required are an RN license (state or compact), BLS certification, and a minimum of three years of clinical experience.

Qualifications

• Associates degree or Diploma in Nursing or Bachelor's in Nursing preferred.
• RN license (single state) or RN-Compact multi-state license required.
• BLS certification required (or equivalent).
• Minimum 3 years of clinical experience required.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services.
• Performs utilization review for admissions, observation, and concurrent cases.
• Communicates with providers and payers to coordinate care and authorization.
• Documents reviews and outcomes in EPIC and escalates issues as needed.

Education

Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System is seeking a Utilization Management Nurse to review medical necessity for admissions and ongoing care across 7 days per week, using Indicia criteria and EPIC documentation. The role collaborates with physicians and care teams to ensure appropriate levels of care and timely discharge planning.

Required are an RN license (state or compact), BLS certification, and a minimum of three years of clinical experience.