Utilization Review RN: Case Management & Discharge Expert

Wellstar Health System, Inc.; Greenfield (SC); On-site; USD 55,000 - 83,000; Part time

Job summary

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for Cobb Hospital in a part-time weekend role. The UM Nurse reviews medical necessity, coordinates care, and communicates with physicians and payers to ensure appropriate level of care and timely authorization.

Strong clinical knowledge and case management experience are required. The position supports patient care transitions and works with EPIC-based documentation to enable accurate billing.

Qualifications

• Minimum 3 years strong clinical knowledge and practice required.
• RN license with current licensure is required.
• Experience with case management and utilization review preferred.

Responsibilities

• Initiates assessment for necessity and appropriateness of health services using established screening criteria (e.g. MCG).
• Ensures timely certification/authorization of hospital admissions and days.
• Documents and communicates with payors and providers to resolve discrepancies.
• Monitors post-discharge/prebill accounts to resolve missing auth numbers and variances.
• Advocates for patient and coordinates care transitions across teams.

Skills

Case Management

Verbal & Written Communication

Organizational Skills

Relationships with Physicians

Screening Criteria

Critical Thinking

Computer Skills

Education

Nursing degree

RN license

Job description

Wellstar Health System, Inc. is seeking a Utilization Management (UM) Nurse for Cobb Hospital in a part-time weekend role. The UM Nurse reviews medical necessity, coordinates care, and communicates with physicians and payers to ensure appropriate level of care and timely authorization.

Strong clinical knowledge and case management experience are required. The position supports patient care transitions and works with EPIC-based documentation to enable accurate billing.