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Director Utilization Management Jobs in Decatur, GA

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management ... DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549

Pharmacy Careers

Appeals Pharmacist (Remote)

Lawrenceville, GA · On-site +1

$49.50 - $60.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Atlanta, GA · On-site +1

$55 - $67/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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Director Utilization Management information

See Decatur, GA salary details

$17.6K

$51.1K

$82K

How much do director utilization management jobs pay per year?

As of Jun 4, 2026, the average yearly pay for director utilization management in Decatur, GA is $51,083.00, according to ZipRecruiter salary data. Most workers in this role earn between $39,100.00 and $58,600.00 per year, depending on experience, location, and employer.

What is a Director Utilization Management job?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What are the typical daily responsibilities of a Director Utilization Management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
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Director Utilization Management jobs near you

Director - Care Management

Piedmont Healthcare Inc.

Stockbridge, GA • On-site

Full-time

Posted 29 days ago

Piedmont Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 449 frontline employees who took The Breakroom Quiz

402nd of 865 rated healthcare providers

Job description

Overview
Experience the advantages of real career change!
Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.
Responsibilities
The Director Care Management is responsible for leading the hospital's Care Management department, defining and maintaining standards of practice for service delivery and organizational performance strategies consistent with PHC's Mission, Vision and Values, as well as those of the individual hospital.
What you will do
  • Provides performance improvement, operational, human resources and financial management of the Care Management department.
  • Ensures that Care Management services, which include case management and social work, are delivered in accordance with evidence-based guidelines, established standards of care practice and performance, hospital policies and procedures.
  • Pursue strategies and day-to-day operations that promote quality patient throughput in a resource/cost effective manner via effective care coordination and discharge planning.
  • Ensures that department operations and delivery align with PHC and industry quality standards.
  • Effectively promote Care Management practices as they relate to the use of software, e.g., InterQual, and IT systems, leveraging for information / data collection, analysis and reporting.
  • Monitor effectiveness by analyzing Average Length of Stay, Case Mix Index, avoidable days, denials, and other key metrics.
  • Reports on regular basis with Chief Financial Officer regarding Care Management department.
  • Implements and ensures collaborative working relationship with hospital and PHC leadership, the Utilization Management (UM) team and centralized functions, physicians, nursing, ancillary services and other key stakeholders.
  • Works closely with UM leadership and Revenue Cycle to ensure issues are addressed in a timely matter, and that functions & processes align.
  • Oversees monitoring of staff utilization based on workload, skill level, acuity and economic constraints.
  • Participates in Director and Leadership activities for hospital and PHC.
  • Actively participates in strategic planning.
  • Ensures a safe work environment for CM staff.
  • Ensures appropriate training and resources are available to all staff within budgetary constraints, and promotes professional growth of all staff.
  • Ensure that staff are consistently informed of departmental, hospital, PHC and general CM issues.
  • Delegates responsibilities to appropriate personnel and ensures completion in a timely and effective manner.
  • Notifies and consults with Risk Management as appropriate and per policy.
  • Provides leadership in recruitment and retention activities; performs or participates in screening, interviewing and selection of employees.
  • Implements Human Resources policies for performance plans, deployment, severance, out-placement, and other policies that support appropriate utilization of workforce resources.
  • Ensure that personnel and competency files are maintained in accordance with hospital, PHC, The Joint Commission and industry standards.
  • Performs outreach activities with community based provider practices and agencies to promote care coordination and support the CM departmental, hospital and PHC goals, as appropriate.

Qualifications
Education
  • Graduate from a nursing program Required or
  • Bachelor's Degree in Social Work, Healthcare Administration, or other related field Required
  • Master's degree Additional certification or Master's in healthcare administration and / or finance Preferred
Work Experience
  • 7 years of case management or social work experience in an acute care setting, to include three (3) years of management experience in the acute setting Required
  • Required
  • Experience using InterQual or Milliman Required
Licenses and Certifications
  • Licensure or eligible for licensure, in the state of Georgia for one of the following: Upon Hire Required
  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Unrestricted registered nurse (RN) license, or eligible for RN licensure, in the state of Georgia Required or
  • LMSW - Licensed Medical Social Worker - State Licensure current unrestricted licensed Master Social Worker (LMSW) Required or
  • LCSW- License Clinical Social Worker licensed Clinical Social Worker (LCSW), Required
  • CCM - Certified Case Manager or Certified Care Management Preferred

Business Unit : Company Name
Piedmont Henry Hospital

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