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Insurance Utilization Reviewer Jobs in Georgia (NOW HIRING)

UHS

Utilization Review Clinician

Augusta, GA

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

UHS

Utilization Review Clinician

Augusta, GA

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

UHS

Utilization Review Clinician

Augusta, GA · On-site

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

Lancesoft INC

Utilization Review RN

Atlanta, GA · On-site

$3.0K - $3.1K/wk

Utilization Review RN - Target Review * Health Plan Insurance (no acute care) * BLS (AHA) * RN state license Company Description LanceSoft is rated as one of the largest staffing firms in the US by ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is r esponsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA

The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Augusta, GA · On-site

The Director of Utilization Review is responsible for the collection, analysis and articulation of required clinical data to insurance providers to obtain authorizations and ensure coordination with ...

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Insurance Utilization Reviewer information

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Georgia? For Insurance Utilization Reviewer jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Georgia look for? The top searched job categories for Insurance Utilization Reviewer jobs in Georgia are:
What cities in Georgia are hiring for Insurance Utilization Reviewer jobs? Cities in Georgia with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Georgia as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Travel Utilization Review

AMN Healthcare Revenue Cycle

Atlanta, GA • On-site

$1.8K - $2.7K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

AMN Healthcare Revenue Cycle is seeking a travel Utilization Review for a travel job in Atlanta, Georgia.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: Therapy
  • Start Date: 08/10/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours
  • Employment Type: Travel

Job Description & Requirements
Utilization Review (UR)
StartDate: 8/10/2026 Pay Rate: $1800.00 - $2700.00
POSITION SUMMARY Utilization Review (UR)
POSITION DUTIES 

UR RN

Care at Home - Home Health

No home visits required


MINIMUM REQUIRED QUALIFICATIONS RN 
PREFERRED QUALIFICATIONS Kaiser Experience Preferred
LENGTH OF ASSIGNMENT 13 weeks
SHIFT / HOURS PER WEEK 08:30 AM to 05:00 PM (40)
SYSTEMS EPIC
START DATE ASAP
Facility Location
With its alluring charm and energetic buzz, Atlanta beckons newcomers from near and far. Part Southern belle, part economic powerhouse, the capital of Georgia is a favorite destination for travel nurses in search of career-boosting assignments, while the city’s numerous entertainment options and warm Southern hospitality make it a great place to call home.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3545073. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Utilization Review (UR)

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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