Weekend Utilization Review RN — Elevate Patient Care

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

Job summary

Wellstar Health System, Inc. is seeking an experienced Utilization Management (UM) Nurse for weekend shifts at Cobb hospital.

The role involves medical necessity reviews using MCG indices, authorizations, and collaboration with physicians to ensure safe transitions of care. You will review admissions, observation cases, and concurrent reviews, document in EPIC, and communicate with payers to resolve discrepancies.

Qualifications

• Associates Nursing or Diploma required; Bachelor’s preferred.
• RN license in good standing required.
• Minimum 3 years of clinical experience in nursing or case management.
• Knowledgeable in case management processes and documentation.

Responsibilities

• Perform utilization reviews and medical necessity reviews.
• Ensure timely certifications/authorizations for hospital admissions and days.
• Document in EPIC and communicate with payors and physicians.
• Coordinate post-discharge planning and avoidable day management.
• Collaborate with care teams to ensure appropriate level of care.

Skills

Case Management

Verbal & written communication

Organizational skills

Relationship building with physicians

Screening criteria knowledge

Critical thinking

Computer skills

Education

Associates Nursing or Diploma

Bachelors Nursing-Preferred

Job description

Wellstar Health System, Inc. is seeking an experienced Utilization Management (UM) Nurse for weekend shifts at Cobb hospital.

The role involves medical necessity reviews using MCG indices, authorizations, and collaboration with physicians to ensure safe transitions of care. You will review admissions, observation cases, and concurrent reviews, document in EPIC, and communicate with payers to resolve discrepancies.