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Care Review Processor Jobs in Georgia (NOW HIRING)

Kaiser Permanente

RN, Targeted Review

Atlanta, GA · On-site

Performs quality of care and service reviews using identified quality indicators. Coordinates and ... process. Builds effective working relationships with physicians and other departments within the ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... Any Oscar applicant who requires reasonable accommodations during the application process should ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$30.71/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$30.71/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St Joseph'S/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$18 - $24.25/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$32.75/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$32.75/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$32.75/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - SJ

Savannah, GA · On-site

$30.71/hr

The care coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - CH

Savannah, GA · On-site

$32.75/hr

The Care Coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - CH

Savannah, GA · On-site

$32.75/hr

The Care Coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - CH

Savannah, GA · On-site

$32.75/hr

The Care Coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

St. Joseph's/Candler

Care Coordinator - CH

Savannah, GA · On-site

$32.75/hr

The Care Coordinator assumes responsibility and accountability for the collaborative process that ... Review action items created during MDRs at the daily 2pm touchpoint meetings to determine ...

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How much do care review processor jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for care review processor in Georgia is $14.14, according to ZipRecruiter salary data. Most workers in this role earn between $11.35 and $16.25 per hour, depending on experience, location, and employer.

What is a care review processor?

A Care Review Processor is responsible for reviewing medical claims, authorizations, and healthcare documentation to ensure accuracy, completeness, and compliance with company policies and regulations. They work with healthcare providers, insurance companies, and internal teams to process claims efficiently. Their role helps streamline patient care by validating medical necessity and ensuring proper claim adjudication. Strong attention to detail and knowledge of medical terminology are essential for success in this position.

What are the typical daily responsibilities of a care review processor?

As a Care Review Processor, your day-to-day responsibilities usually include reviewing medical records and authorization requests, verifying insurance coverage, ensuring documentation is complete, and coordinating with healthcare providers to clarify information. You may also be responsible for entering data into claims systems, communicating with patients or case managers, and helping to resolve discrepancies or incomplete submissions. Most of your work will involve close attention to detail and following established healthcare or insurance processes. Teamwork is often part of the role, as you may collaborate with clinicians, billing teams, and customer service representatives to facilitate accurate and timely care reviews.

What are the key skills and qualifications needed to thrive in the care review processor position, and why are they important?

A Care Review Processor requires a solid understanding of healthcare procedures, medical terminology, and insurance guidelines, typically supported by experience in medical claims or healthcare administration. Familiarity with claims management software, electronic health records (EHR) systems, and Microsoft Office is often necessary, along with knowledge of HIPAA compliance requirements. Strong attention to detail, organizational skills, and the ability to communicate effectively with medical professionals and insurance providers are vital soft skills. These competencies ensure accurate review and processing of care requests while supporting efficient, compliant healthcare operations.

What are the most commonly searched types of Care Review Processor jobs in Georgia?

The most popular types of Care Review Processor jobs in Georgia are:

What are popular job titles related to Care Review Processor jobs in Georgia?

For Care Review Processor jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Care Review Processor jobs in Georgia look for?

The top searched job categories for Care Review Processor jobs in Georgia are:

Care Review Processor jobs near you
Infographic showing various Care Review Processor job openings in Georgia as of August 2026, with employment types broken down into 2% As Needed, 74% Full Time, 18% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $29,403 per year, or $14.1 per hour.

RN, Specialty Care Review On Call PRN

Kaiser Permanente

Atlanta, GA • On-site

Other

Re-posted 23 days ago

Kaiser Permanente rating

8.2

Company rating: 8.2 out of 10

Based on 923 frontline employees who took The Breakroom Quiz

54th of 895 rated healthcare providers

Job description

Job Summary:
Responsible for carrying out medical necessity reviews on all designated referrals for Home Care, DME Specialty Care services. The activities will include telephonic review for medical necessity of the designated services using established criteria and guidelines for coordination of services. Eligibility and benefit reviews will be performed as necessary. Identification of patients for case management, quality improvement reviews, and communication with inpatient care coordinators, case managers, providers, Customer Service, Claims, Contracts and Benefits - Appeals, Risk Management are responsibilities of the position.
Essential Responsibilities:
  • Responsible for the day to day review activities as outlined above. Utilizes established criteria to perform medical necessity review for all members requiring home health and DME services. All referral reviews will be performed within the required timeframe and with adherence to the decision notification process. Refers all cases that do not meet established criteria to the appropriate review physician. Performs benefit and eligibility reviews on referrals. Provides investigation and preparation of cases requiring review of the Chief of QRM according to the established guidelines. Understands the Complex Case Management Program and referral process; Refers patients to the Complex Case Managers according to procedure. Provides correspondence in accordance to policy and procedure for members with respect to service requests. Interacts with vendors to ensure that resources are being utilized appropriately while maintaining quality outcomes.
    • Establishes and maintains contact with case manager regarding requests and review status as appropriate.
    • Refers the patient to the social workers as appropriate. Performs quality of care and service reviews using identified quality indicators. Reviews the utilization reports with the Supervisor to assure appropriateness of reviews and makes adjustments based on findings. Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management. Maintains effective interaction/communication with members of the medical staff, health care teams, intake coordinators, complex case managers, social workers, inpatient care coordinators, referral coordinators, Member Services, Claims, Contracts and Benefits-Appeals, Risk Management and Kaiser Permanente medical offices to facilitate the review process. Builds effective working relationships with other department. Under the guidance of the supervisor, participates in the maintenance of all QRM policies and procedures related to the Transitional Care Review Program. Participates in call rotation to support after hours and weekend requests for quality resource management services.Refers cases identified as risk management, peer review or quality issues to QAIR and Risk Management.
    • Document Review Activities according to documentation guidelines. Issue letters of non - coverage to members not meeting established medical necessity criteria. Works cross-functionally with other departments in striving to meet organizational goals and objectives. Achieves and maintains an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management. Knowledgeable and compliant with regional personnel policies and procedures. Knowledgeable and compliant with QRM departmental and unit specific policies and procedures. Participates in annual regional and departmental compliance training. Knowledgeable and compliant with Principles of Responsibility. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanentes policies and procedures.
    • Responsible for assisting the Medical Office Administration, Customer Services and Provider Relations in investigating concerns and issues. Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform the job. Demonstrates understanding of HIPAA privacy regulations by maintaining confidentiality of Protected Health Information (PHI). Demonstrates doing the right thing and doing things the right way is an underlying premise in all work related activities and is able to identify location of copy of Principles of Responsibility. Develops and maintains an awareness of how to report compliance issues and concerns. Identifies issues of wrong doing and promptly investigates and reports to immediate supervisor or Director of Regional Compliance. Assures an atmosphere and culture for staff to report issues of wrong doing. Other duties as assigned.
Basic Qualifications:
Experience
  • Minimum three (3) years of clinical nursing OR completed Kaiser Permanente Nurse Residency Program in KP Georgia.
Education
  • B.S. in Nursing or four (4) years of directly related experience.
  • High school diploma or GED required.
License, Certification, Registration
  • Registered Professional Nurse License (Georgia)
Additional Requirements:
  • Working knowledge of all relevant federal, state, local and regulatory requirements, including Medicare.
  • Functional knowledge of computers.
  • Experience in ICD9/CPT4 coding.
  • Experience in home health and durable medical equipment coordination.
  • Experience with managed health care delivery systems.
Preferred Qualifications:
  • Minimum three (3) years of clinical nursing with preferred experience home health, rehabilitation or skilled nursing care.
  • Minimum two (2) years of experience in utilization or case management, discharge planning and quality improvement in a managed care or health care setting preferred.
  • Preferred experience with managed care or health care delivery systems.
  • CCM preferred.
  • B.S. in Nursing.

Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Employee Status: Regular
Worker Location: Onsite
Employee Group/Union Affiliation: GUP|UFCW|Local 1996
Job Level: Entry Level
Department: Regional Office - 9 Piedmont - UR-Care at Home - 2808
Pay Range: $40.35 - $51.59 / hour Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

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