Utilization Review Registered Nurse, PRN

St. Mary's Health Care System; Athens (GA); On-site; USD 30,000 - 47,000; Part time

Job summary

St. Mary's Health Care System in Georgia seeks a part-time Utilization Review (UR) Coordinator to ensure patients receive the appropriate level of care and to optimize resource use across the continuum of hospitalization.

This role collaborates with physicians, nurses, patient access, billing, and external payers, conducts reviews against medical necessity criteria, and acts as a liaison to secure timely authorizations and effective communication with payers, always prioritizing compassionate,

Responsibilities

• Collaborates with physicians, nurses, patient access staff, billing personnel, and external payers to ensure patients receive the appropriate level of care throughout hospitalization.
• Conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and resource utilization.
• Acts as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, and authorization requirements.

Job description

Employment Type: Part time Shift: Description:

Position Summary

The Utilization Review (UR) Coordinator collaborates with a multidisciplinary team, including physicians, nurses, patient access staff, billing personnel, and external payers, to ensure patients receive the appropriate level of care throughout the continuum of care in an efficient, cost-effective, and quality-focused manner. The UR Coordinator conducts clinical reviews using established medical necessity criteria to support accurate patient status determinations and appropriate resource utilization throughout hospitalization. This role serves as a liaison between the hospital and external payers regarding medical necessity, severity of illness, intensity of service, authorization requirements, and timely utilization of hospital services.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.