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Chart Utilization Review Jobs in Georgia (NOW HIRING)

Serene Health

RN Case Manager

Augusta, GA

$32 - $40/hr

... or utilization patterns. * Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements. * Participate in audits, chart reviews, and quality improvement ...

Serene Health

RN Case Manager

Augusta, GA · On-site

$32 - $40/hr

... or utilization patterns. * Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements. * Participate in audits, chart reviews, and quality improvement ...

Socket.dev

Clinical Compliance Specialist

Atlanta, GA · On-site

$90 - $120/hr

Oversee operational readiness for audits, accreditation reviews, licensing inspections, and ... Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.

Chris180

Clinical Compliance Specialist

Atlanta, GA · On-site

$50K - $60K/yr

... reviews, licensing inspections, and regulatory surveys. • Monitor compliance metrics and ... Utilization Management to ensure compliance. • Develop educational resources and deliver ...

Chris 180

Clinical Compliance Specialist

Atlanta, GA · On-site

$50K - $60K/yr

... reviews, licensing inspections, and regulatory surveys. · Monitor compliance metrics and implement ... with Utilization Management to support their insurance paneling & credentialing efforts.

CHRIS 180

Clinical Compliance Specialist

Atlanta, GA · Hybrid

$50K - $60K/yr

Oversee operational readiness for audits, accreditation reviews, licensing inspections, and ... Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.

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Showing results 21-40

All JobsChart Utilization Review JobsChart Utilization Review Jobs in Georgia

Chart Utilization Review information

What is chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

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

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

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

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

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

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

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution.

RN Case Manager

Serene Health

Augusta, GA

$32 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Key responsibilities

  • Conduct clinical assessments based on medical history, diagnoses, utilization patterns, medications, and risk indicators.

  • Develop, review, and clinically approve individualized ECM care plans.

  • Provide RN clinical oversight and guidance to ECM Lead Care Managers executing care plans.

Job description

Empowering Wellness, Transforming Lives

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.

As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.

Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.

A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!

Job Summary: 

The RN Clinical Case Manager provides clinical assessment, care plan development, and ongoing clinical oversight within the Enhanced Care Management (ECM) program. 

This is a non-bedside, RN-led role. The RN Clinical Case Manager serves as the clinical authority for ECM care planning, ensuring medical appropriateness, risk identification, and regulatory compliance. The RN works in close collaboration with ECM Lead Care Managers, who are responsible for care coordination, member engagement, and non-clinical assessments. 

Core Responsibilities: 

  • Conduct clinical assessments based on medical history, diagnoses, utilization patterns, medications, and risk indicators. 
  • Develop, review, and clinically approve individualized ECM care plans. 
  • Identify and monitor clinical and utilization risks impacting member outcomes. 
  • Provide RN clinical oversight and guidance to ECM Lead Care Managers executing care plans. 
  • Review medication lists for safety concerns, adherence issues, and escalation needs. 
  • Collaborate with primary care providers, behavioral health clinicians, and internal care teams. 
  • Support transitions of care following emergency department visits, hospitalizations, or other significant events. 
  • Ensure care plans are updated based on changes in clinical status or utilization patterns. 
  • Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements. 
  • Participate in audits, chart reviews, and quality improvement initiatives. 
  • Provide clinical education and consultation to ECM staff as needed. 
  • Contribute to the development and refinement of clinical workflows, tools, and best practices. 
  • Maintain timely, accurate, and compliant clinical documentation. 
  • Prepare clinical summaries, care plan updates, and progress notes. 
  • Support internal reporting related to member outcomes, utilization, and care plan progress. 
  • Performs other duties as assigned.  

Required Qualifications:  

  • Active California & GA RN license. 
  • Associate Degree in Nursing (ADN) required; BSN preferred. 
  • Minimum 3 years of clinical nursing experience. 
  • Experience working with Medi-Cal and/or managed care populations. 
  • Strong clinical judgment and communication skills. 
  • Ability to work independently and collaboratively. 

Preferred Qualifications 

  • Bilingual English/Spanish 
  • Case management or utilization management experience. 
  • Familiarity with Enhanced Care Management (ECM) or Health Home programs. 
  • Experience supporting audits or regulatory reviews. 
  • Training in Motivational Interviewing or trauma-informed care. 

Physical Requirements:  

  • Prolonged periods of computer-based work. 
  • Ability to lift 10 pounds. 
  • Flexibility to support program operations. 
Pay range
$32—$40 USD

Benefits

Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:

Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long-Term Disability Benefits: Protection when you need it most.

Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.

Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way.

401(K): Building your financial future with us. Effective after 1 year of employment.

Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations.

Employee Referral Program: Share the opportunities and reap the rewards.

Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment

Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.