Weekend Utilization Review RN: Drive Care Outcomes

Wellstar Health System, Inc.; Austell (GA); On-site; USD 85,000 - 120,000; Part time

Job summary

The Utilization Management (UM) Nurse at Wellstar Cobb Medical Center conducts medical necessity reviews and applies MCG criteria. They coordinate with physicians and the care team to ensure safe transitions of care and timely payer authorizations.

With at least 3 years of clinical experience and RN licensure, the role emphasizes accurate EPIC documentation, communication with payors, and post-discharge review to optimize outcomes and throughput.

Qualifications

• Minimum 3 years strong clinical knowledge with clinical practice/experience.
• RN license in good standing; Single State or Compact license.
• Experience with Case Management and utilization review.
• Excellent communication and organizational skills.

Responsibilities

• Conduct medical necessity reviews using established criteria (MCG).
• Certify/authorize hospital admissions and days in a timely manner.
• Provide required information to payors and obtain authorizations.
• Document reviews in EPIC and communicate with physicians and payors.
• Coordinate care transitions with the care team and physicians.
• Monitor post-discharge/prebill accounts and document discrepancies.

Skills

Clinical knowledge

Communication skills

Organizational skills

Computer skills

Education

Associates Nursing or Diploma

Bachelors Nursing-Preferred

Tools

EPIC

Indicia

Job description

The Utilization Management (UM) Nurse at Wellstar Cobb Medical Center conducts medical necessity reviews and applies MCG criteria. They coordinate with physicians and the care team to ensure safe transitions of care and timely payer authorizations.

With at least 3 years of clinical experience and RN licensure, the role emphasizes accurate EPIC documentation, communication with payors, and post-discharge review to optimize outcomes and throughput.