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Cvs Health Utilization Management Jobs in Georgia

LCMC Health

This role ensures appropriate use of healthcare services, regulatory compliance, and optimal ... In conjunction with the Corp VP, Case Management & Utilization, develop and implement a system-wide ...

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Job Title Utilization Management Nurse The Utilization Management Nurse performs comprehensive ... Health & Wellness Program * Health Savings Account * Life & AD&D Insurance * Long Term Disability

VEST MONROE LLC

Utilization Management Coordinator

Monroe, GA · On-site

$25 - $28/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As a Utilization Management Coordinator, you'll be an integral part of our treatment team ... If you are passionate about mental health care and ready to make a meaningful difference in the ...

HealthOne Alliance

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources ... JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested ...

HealthOne Alliance

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources ... JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested ...

HealthOne Alliance

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources ... JOB PURPOSE The Utilization Management Nurse performs comprehensive clinical reviews of requested ...

UHS

UTILIZATION MANAGEMENT COORDINATOR

Sautee, GA · On-site

  • Medical

  • Dental

  • Vision

  • PTO

Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network ... Once a care manager is established, contacts health plan provider and requests most appropriate LOC ...

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... Health, Dependent and Transportation Flexible Spending Accounts * Employee, Spouse and Dependent ...

Clarvida

Utilization Manager

Savannah, GA

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Performs Utilization Management reviews, to include On Hold reports, and coordinates resolution of ... Health, Dependent and Transportation Flexible Spending Accounts * Employee, Spouse and Dependent ...

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Cvs Health Utilization Management information

What is CVS Health Utilization Management?

CVS Health Utilization Management refers to a set of services and processes used to ensure that patients receive appropriate, effective, and efficient health care. This involves reviewing medical necessity, appropriateness, and efficiency of health care services, procedures, and facilities under the provisions of a health benefits plan. At CVS Health, Utilization Management professionals work with healthcare providers, payers, and patients to optimize care outcomes while controlling costs. They help determine coverage decisions, coordinate care, and assist in managing complex cases.

What is the difference between Cvs Health Utilization Management vs Cvs Health Case Management?

AspectCvs Health Utilization ManagementCvs Health Case Management
Primary FocusReviewing and authorizing healthcare services to ensure appropriate utilizationCoordinating patient care and connecting patients with resources
Work EnvironmentUtilization review teams, insurance settingsPatient homes, healthcare facilities, community settings
CredentialsRN, LPN, or other healthcare certificationsRN, social worker, or case management certifications
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers

While both roles involve healthcare professionals, Utilization Management focuses on reviewing services for appropriateness, whereas Case Management emphasizes coordinating comprehensive patient care. Understanding these differences helps in choosing the right career path or job search focus within the healthcare industry.

What are some typical challenges faced by CVS Health Utilization Management professionals, and how can they be addressed?

Utilization Management professionals at CVS Health often encounter challenges such as balancing clinical decision-making with cost-effectiveness, managing high caseloads, and navigating complex insurance policies. Staying updated on healthcare regulations, maintaining clear communication with providers, and leveraging the company's decision-support tools can help address these challenges. Regular collaboration with interdisciplinary teams also ensures that patient care remains the top priority while meeting organizational guidelines.

What are the key skills and qualifications needed to thrive in CVS Health Utilization Management?

To thrive as a CVS Health Utilization Management Nurse, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of insurance guidelines and regulatory requirements is typically expected. Excellent communication, attention to detail, and critical thinking skills help in advocating for patients and collaborating with healthcare providers. These skills ensure effective care coordination, compliance with policies, and optimized patient outcomes in a managed care environment.

What are the most commonly searched types of Cvs Health Utilization Management jobs in Georgia?

The most popular types of Cvs Health Utilization Management jobs in Georgia are:

What are popular job titles related to Cvs Health Utilization Management jobs in Georgia?

For Cvs Health Utilization Management jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Cvs Health Utilization Management jobs in Georgia look for?

The top searched job categories for Cvs Health Utilization Management jobs in Georgia are:

What cities in Georgia are hiring for Cvs Health Utilization Management jobs?

Cities in Georgia with the most Cvs Health Utilization Management job openings:

Cvs Health Utilization Management jobs near you
Infographic showing various Cvs Health Utilization Management job openings in Georgia as of August 2026, with employment types broken down into 48% As Needed, and 52% Part Time. Highlights an 100% In-person job distribution.

Manager Utilization Management-Behavioral Health

Piedmont Healthcare Inc.

Atlanta, GA • On-site

Full-time

Posted 17 days ago

Piedmont Healthcare rating

7.1

Company rating: 7.1 out of 10

Based on 466 frontline employees who took The Breakroom Quiz

380th of 887 rated healthcare providers

Job description

Responsibilities
Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance. Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations.
Qualifications
Education
  • Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required
Work Experience
  • 5 years of experience in Behavioral Health Utilization Management and Utilization Review processes using medical necessity criteria (InterQual and/or Milliman).
  • 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting Required
  • Experience working in a system-level or multi-site environment Preferred
Licenses and Certifications
  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required or
  • LPC-Licensed Professional Counselor Required or
  • LMSW - Licensed Medical Social Worker - State Licensure Required or
  • LCSW- License Clinical Social Worker Required or
  • Licensed Marriage and Family Therapist (LMFT) Required
  • IQCI Certification Required

Business Unit : Company Name
Piedmont Healthcare Corporate

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