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Behavioral Utilization Review Jobs in Georgia (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing ...

Elevance Health

Utilization Management Rep I

Columbus, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...

Alliant Health Solutions

Review Nurse-PA/UM

Atlanta, GA · On-site

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management ... skills and positive behaviors * Maintain security and confidentiality of all information in ...

Alliant Health Solutions, Inc.

Review Nurse-PA/UM

Atlanta, GA · On-site

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management ... skills and positive behaviors * Maintain security and confidentiality of all information in ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management ... skills and positive behaviors * Maintain security and confidentiality of all information in ...

Elevance Health

Utilization Management Rep I

Columbus, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...

Elevance Health

Utilization Management Rep I

Columbus, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...

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Behavioral Utilization Review information

What is the difference between Behavioral Utilization Review vs Behavioral Case Manager?

AspectBehavioral Utilization ReviewBehavioral Case Manager
CredentialsLicensed mental health professionals, certifications varyLicensed clinical social workers, counselors, or therapists
Work EnvironmentReview settings, insurance companies, healthcare facilitiesDirect patient interaction, hospitals, outpatient clinics
Employer & IndustryInsurance companies, healthcare organizationsHospitals, mental health agencies, managed care
Primary FocusAssessing medical necessity, reviewing treatment plansCoordinating care, supporting treatment adherence

Behavioral Utilization Review primarily involves evaluating the necessity of mental health services through review processes, while Behavioral Case Managers focus on coordinating patient care and supporting treatment plans. Both roles require mental health credentials but differ in daily tasks and work settings.

How to become a behavioral utilization review?

To become a behavioral utilization review specialist, candidates typically need a bachelor's degree in psychology, social work, nursing, or a related field. Relevant experience in mental health or healthcare settings, along with knowledge of insurance policies and utilization review processes, is important; some roles may require certification such as the Certified Professional in Utilization Review (CPUR).

Is behavioral utilization review a stressful job?

Behavioral utilization review can be stressful due to the need to evaluate complex mental health cases, meet strict deadlines, and handle sensitive patient information. The role often requires strong attention to detail, critical thinking, and emotional resilience, which can contribute to job-related stress.

What are popular job titles related to Behavioral Utilization Review jobs in Georgia?

For Behavioral Utilization Review jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Behavioral Utilization Review jobs in Georgia look for?

The top searched job categories for Behavioral Utilization Review jobs in Georgia are:

What cities in Georgia are hiring for Behavioral Utilization Review jobs?

Cities in Georgia with the most Behavioral Utilization Review job openings:

Behavioral Utilization Review jobs near you
Infographic showing various Behavioral Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 100% In-person job distribution.

Utilization Specialist

Acadia Healthcare

Valdosta, GA • On-site

Full-time

Re-posted 2 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 190 frontline employees who took The Breakroom Quiz

701st of 887 rated healthcare providers

Job description

Overview
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities
ESSENTIAL FUNCTIONS:
  • Act as liaison between managed care organizations and the facility professional clinical staff.
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
  • Conduct quality reviews for medical necessity and services provided.
  • Facilitate peer review calls between facility and external organizations.
  • Initiate and complete the formal appeal process for denied admissions or continued stay.
  • Assist the admissions department with pre-certifications of care.
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:
  • Perform other functions and tasks as assigned.

Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
  • Required Education: High school diploma or equivalent.
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:
  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
  • First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

What Acadia Healthcare employees say

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About Acadia Healthcare

Sourced by ZipRecruiter

Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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