Utilization Management RN — Optimize Care & Authorizations

Wellstar Health System, Inc.; United States; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Sign-on bonus

Relocation assistance

Job summary

Wellstar Cobb Hospital is seeking a Utilization Management (UM) Nurse to perform medical necessity reviews and coordinate safe transitions of care. The role requires strong clinical knowledge and collaboration with physicians and care teams to optimize patient outcomes.

Responsibilities include daily utilization reviews, obtaining authorizations, and documenting in EPIC, with ongoing participation in performance improvement and post-discharge follow-up.

Qualifications

• Graduate of an accredited nursing program.
• BSN degree required.
• Active RN license.

Responsibilities

• Initiates and coordinates utilization management reviews using established screening criteria (e.g. MCG).
• Ensures timely certification/authorization of hospital admissions and days, documenting in EPIC and communicating with payors.
• Monitors post-discharge/prebill accounts to resolve discrepancies and ensure accurate documentation.
• Supports performance improvement initiatives and collaborates with physicians and care teams.

Skills

Case management

Verbal & written communication

Organizational skills

Relationship building with physicians

Screening criteria review

Critical thinking

Computer skills

Education

BSN degree

RN license

Job description

Wellstar Cobb Hospital is seeking a Utilization Management (UM) Nurse to perform medical necessity reviews and coordinate safe transitions of care. The role requires strong clinical knowledge and collaboration with physicians and care teams to optimize patient outcomes.

Responsibilities include daily utilization reviews, obtaining authorizations, and documenting in EPIC, with ongoing participation in performance improvement and post-discharge follow-up.