Utilization Management RN Team Lead

Health Marketing; Marietta (GA); On-site; USD 70,000 - 100,000; Full time

Job summary

Health Marketing seeks an experienced nurse to lead on-site utilization review staff and coordinate concurrent reviews across the full continuum of care. The role involves collaborating with physicians and multidisciplinary teams to assess medical necessity, patient status, throughput, and documentation.

Responsibilities include applying clinical criteria to determine level of care, delivering notices, and supporting compliance throughout the utilization review process.

Qualifications

• Experience in utilization management and concurrent review.
• Ability to apply clinical criteria to medical necessity decisions.
• Strong communication with physicians and multidisciplinary teams.

Responsibilities

• Lead on-site utilization review nursing staff and coordinate concurrent reviews.
• Collaborate with physicians and interdisciplinary teams to support medical necessity and throughput.
• Conduct concurrent reviews using established criteria to determine appropriate level of care.
• Deliver required notices and support compliance in the utilization review process.
• Implement strategies to prevent denials and address utilization issues proactively.
• Monitor nursing staff performance and workflow for efficient review operations.
• Coordinate and facilitate reviews to ensure defensible documentation and decision-making.

Skills

Utilization management

Concurrent review

Nursing leadership

Documentation & compliance

Interdisciplinary collaboration

Job description

Role Summary

Leads on-site utilization management nursing staff and coordinates concurrent reviews across the full continuum of care.

Key Duties

• Collaborate with physicians and interdisciplinary teams to support medical necessity, patient status assessment, throughput management, and accurate documentation.
• Conduct concurrent reviews using established clinical criteria to determine appropriate level of care.
• Deliver required notices and support compliance throughout the utilization review process.
• Implement strategies to prevent denials and address utilization issues proactively.
• Monitor nursing staff performance and workflow to ensure efficient, high-quality review operations.
• Coordinate and facilitate reviews to ensure consistent, defensible documentation and decision-making.

Qualifications & Skills

• Strong clinical nursing knowledge with expertise in utilization management and concurrent review.
• Ability to apply clinical criteria to support medical necessity determinations.
• Excellent communication and collaboration skills with physicians and multidisciplinary teams.
• Strong documentation, compliance, and notice delivery skills.
• Leadership capability with experience managing workflow and staff performance.