Be Seen First
Duluth, GA · On-site
$110K - $114K/yr
Validate product workflows against real‐world SNF operations (admissions, concurrent review, length‐of‐stay, discharge planning). * Provide subject‐matter expertise on UR/UM requirements ...
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Be Seen First
Duluth, GA · On-site
$110K - $114K/yr
Validate product workflows against real‐world SNF operations (admissions, concurrent review, length‐of‐stay, discharge planning). * Provide subject‐matter expertise on UR/UM requirements ...
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Statesboro, GA · On-site
$16.09/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Warner Robins, GA · On-site
$80 - $100/hr
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Warner Robins, GA · On-site
$80 - $100/hr
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Warner Robins, GA · On-site
$90 - $110/hr
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Warner Robins, GA · On-site
$90 - $110/hr
Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The ...
The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The ...
Pembroke, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Pembroke, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The ...
The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The ...
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Pembroke, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Pembroke, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
Savannah, GA · On-site
$18.15/hr
Perform initial review prior to date of service and concurrent review until precertification obtained. Communicate and collaborate with other departments to eliminate precertification denials.
In addition, concurrent reviews will be completed as required by the payers, by accurately applying appropriate criteria sets. The UR RN (PRN) will ensure that all reviews are completed timely ...
In addition, concurrent reviews will be completed as required by the payers, by accurately applying appropriate criteria sets. The UR RN (PRN) will ensure that all reviews are completed timely ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Actively manages and resolves concurrent payer denials in collaboration with appropriate ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Actively manages and resolves concurrent payer denials in collaboration with appropriate ...
| Aspect | Concurrent Review | Utilization Review |
|---|---|---|
| Purpose | Assess ongoing patient care during hospitalization | Evaluate the necessity and appropriateness of services, often before or after care |
| Timing | Performed in real-time during treatment | Can be pre-authorization, concurrent, or retrospective |
| Work Environment | Hospitals, clinics, insurance companies | Insurance companies, healthcare organizations |
| Credentials | Registered nurses, case managers, healthcare professionals | Medical reviewers, nurses, case managers |
Concurrent Review focuses on evaluating ongoing patient care during hospitalization, ensuring treatments are appropriate in real-time. Utilization Review has a broader scope, including pre-authorization and retrospective assessments to determine the necessity of services. While both roles involve healthcare professionals and are used within insurance and healthcare settings, their timing and specific focus differ.
For Concurrent Review jobs in Georgia, the most frequently searched job titles are:
The top searched job categories for Concurrent Review jobs in Georgia are:
$110K - $114K/yr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 9 days ago
We are seeking a senior‐level Director, Managed Care Strategy to serve as the bridge between product strategy and real‐world managed‐care operations. This role will guide the development and adoption of our healthcare SaaS platform, ensuring it meets the nuanced needs of Medicare Advantage, skilled‐nursing‐facility (SNF) workflows, and utilization management (UR/UM) processes. This role does not involve people‐management responsibilities but requires deep domain expertise and the ability to influence product direction and client success.
This is a hybrid position (3 days in office, 2 days out), based in Duluth, GA.
If you are a seasoned managed‐care professional who enjoys turning clinical expertise into product‐driving insight, we encourage you to apply.
Key Responsibilities
Product Strategy & Direction
• Partner with the Managing Director to shape roadmap priorities and feature design through a managed‐care lens.
• Validate product workflows against real‐world SNF operations (admissions, concurrent review, length‐of‐stay, discharge planning).
• Provide subject‐matter expertise on UR/UM requirements, policies, and operational best practices.
• Pressure‐test product concepts against payer expectations, authorization requirements, and denial trends.
• Identify and articulate gaps between product functionality and operational realities in post‐acute care.
Client Adoption & Enablement
• Support adoption across new and existing clients, acting as a senior managed‐care and clinical resource that floats across accounts.
• Partner with Implementation and Customer Experience teams to accelerate time‐to‐value and remove adoption barriers.
• Participate in strategic client conversations where workflow expertise is critical.
• Help standardize best‐practice workflows while allowing for client‐specific variation.
• Capture client insights and translate them into actionable product and process improvements.
Cross‐Functional Partnership
• Collaborate closely with Product, Development, Customer Success, and Sales teams to align product design, messaging, and market expectations.
• Support go‐to‐market efforts by ensuring product positioning resonates with managed‐care and post‐acute audiences.
• Contribute to internal education around Medicare Advantage, SNF workflows, and UR/UM processes.
Required Experience
• 7 - 10 years in managed care, post‐acute care, or utilization management.
• Deep, hands‐on knowledge of Medicare Advantage (authorization, concurrent review, plan‐provider dynamics).
• Strong understanding of Skilled Nursing Facility (SNF) operations and workflows.
• Direct experience leading or overseeing UR/UM programs, including denials and appeals.
• Proven ability to translate operational realities into strategic and product‐level guidance.
Preferred Background
• Former Director or senior leader in Care Management, Utilization Management, or Clinical Services.
• Background with SNF operators, post‐acute management organizations, or MA‐heavy health systems.
• Experience partnering with healthcare technology or SaaS platforms.
