UM Team Lead RN- Onsite

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Day (United States of America)

The Team Leader is responsible for oversight of staff UM RNs to ensure coordination and function of a team across the continuum during the patient's acute, chronic and long-term stages of illness for a defined patient population. This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members to optimize hospital's throughput, length of stay, and reimbursement accuracy.

The Team Lead of On-site UM is responsible for Training, Supervision, and Coordination of On-site UMstaffing. Provides direction/assistance to all UM Staff, students and Well Star customers. The Team Lead of On-site UM will assist with overall coordination of the department's goals, process improvements, policies and procedures.

It is expected that all RN Clinical Nurses are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association. As a member of the patient services team, it is expected that the individual upholds the voice of the patient, system policies and procedures while supporting service excellence goals.

As an on-site Hospital Utilization Management (UM) Nurse Team Lead, you are the primary link between the clinical floor and administrative compliance. Unlike remote roles, this position relies heavily on real-time, face-to-face interaction with doctors, patients, and interdisciplinary teams to optimize hospital resources.

Physician and Clinical Collaborationo Physician Consultation:
Meet in person with attending/admitting providers to discuss cases where documentation does not support medical necessity or the current level of care.o Medical Provider Liaison:
Function as the primary on-site link between the attending/admitting provider and the Physician Advisor for complex medical necessity determinations.

Real-Time Patient Class Decision Supporto Interdisciplinary Huddles:
Attend daily bedside rounds or departmental "bed huddles" to provide immediate input on medical necessity and criteria-led care progression.o ER Throughput Management:
Provide consultation as needed on cases being admitted through the Emergency Department to assess new admissions and recommendations for the most appropriate level of care.

Administrative & Financial Complianceo Medical Necessity Reviews:
Use criteria like Inter Qual or MCG to perform on-site concurrent reviews of active patient care.o Issuing Official Notices:
Deliver and explain legally required documents in person, such as condition-code 44 or Medicare observation notices (MOON).o Denial Prevention:
Proactively identify "avoidable days"hospital days that do not meet clinical criteria and escal

Team Lead Duties Coordinate care care with Manager, Director and other Healthcare Team Leaders.

Oversee staffing daily staffing/ evaluates daily work distribution regarding levels &demands of staff.

Daily monitoring and coaching of staff productivity and denial ratios, reports for daily volume without medical reviews completed, management of Epic WQs, peer to peer outcomes, E.H.Ruse with outcomes, avoidable days documentation and reporting, and barriers impacting utilization management workflow

Supervise, coach, mentor on general practice.

Head a team of peers to participate in the interviewing process with the Directors.

Manage QA & PI activities

Provides leadership in conflict resolution

Provide guidance during the orientation process ensuring that the new employee is firmly educated in UM and Social Service issues.

Assists with yearly performance evaluations

Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.

Serves as a preceptor and/or or mentor for other…