Utilization Management Registered Nurse (RN), Onsite

Job overview

The Utilization Management Registered Nurse (RN), Onsite role is onsite in Marietta, GA. Compensation is not specified. The position supports Wellstar’s hospital utilization management work and its mission to enhance the health and well-being of the people it serves. The nurse reviews admissions and ongoing care to assess medical necessity, patient class, and payer requirements. Through in-person collaboration with providers and interdisciplinary teams, the role supports appropriate care progression, regulatory compliance, accurate reimbursement, and prevention of avoidable denials and days.

What you'll do

• Conduct timely initial and concurrent medical record reviews using screening criteria
• collaborate with physicians, physician advisors, and managed care representatives on medical necessity and denials
• attend bedside rounds or bed huddles
• consult on emergency department admissions as needed
• monitor payer and Medicare/Medicaid compliance
• deliver and explain required notices
• document reviews and insurance updates
• work post-discharge and prebill accounts
• and escalate documentation or avoidable-day concerns.

What we're looking for

Skills & competencies

utilization management registered nurse

marietta ga

wellstar

onsite

day shift

full-time

medical necessity reviews

patient class

hospital throughput

payer compliance

denial prevention

rn license

bls

clinical experience

Work arrangement

• Weekend coverage required

Why this role

Onsite role requiring face-to-face provider collaboration; requires at least three years of clinical practice experience, RN licensure, and BLS within 90 days.

About the employer

Wellstar Health Systems, Inc. is hiring for this role. Industry: General Medical and Surgical Hospitals. Sector: 62.