Registered Nurse (RN), Utilization Management

Job overview

The Registered Nurse (RN), Utilization Management role is onsite in Augusta, GA. Compensation is not specified. Wellstar’s mission is to enhance the health and well-being of every person it serves. The nurse reviews admissions and ongoing care to assess medical necessity, patient classification, and compliance with payer requirements. By collaborating with providers and care teams, the role supports appropriate care progression, accurate documentation, and prevention of avoidable denials.

What you'll do

• Conduct timely concurrent reviews using screening criteria such as InterQual or MCG
• assess patient class and appropriateness of admission
• collaborate with attending physicians and physician advisors on medical necessity
• monitor payer and Medicare/Medicaid compliance
• attend bedside rounds or bed huddles
• provide Emergency Department admission consultation
• deliver and explain required notices
• document reviews and escalate avoidable days.

What we're looking for

Skills & competencies

registered nurse

utilization management

augusta ga

wellstar

medical necessity

concurrent review

interqual

mcg

patient class

payer compliance

bls

rn license

Work arrangement

• Weekend coverage required

Why this role

Onsite hospital utilization management role; requires an RN license and BLS certification, with BLS permitted within 90 days. Requires at least three years of clinical practice experience.

About the employer

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