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Insurance Utilization Reviewer Jobs in Georgia (NOW HIRING)

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

Utilization Review Nurse (RN)

Augusta, GA

Utilization Review/Business Office Coordinator will ensure input of pre-certifications and ... Verify insurance coverage at the first of the month, and post patient payments into MS4 * Trained ...

UHS

Utilization Review Nurse (RN)

Augusta, GA · On-site

Utilization Review Nurse . Under the direction of the Director of Utilization Management. Website ... Verify insurance coverage at the first of the month, and post patient payments into MS4 * Trained ...

UHS

Utilization Review Nurse (RN)

Augusta, GA

Utilization Review/Business Office Coordinator will ensure input of pre-certifications and ... Verify insurance coverage at the first of the month, and post patient payments into MS4 * Trained ...

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Assists non-clinical staff in performance of administrative reviews. * Performing comprehensive ... Dental Insurance * Employee Assistance Program * Flexible Spending Account * Health & Wellness ...

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Insurance Utilization Reviewer information

What is an insurance utilization reviewer?

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 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 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 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 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 Nurse RN - Utilization Review

Medlivo

Atlanta, GA • On-site

Contractor

Medical, Dental, Vision, Life, Retirement

Posted 22 days ago

Job description

Medlivo is seeking a travel nurse RN Utilization Review for a travel nursing job in Atlanta, Georgia.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

Requirements:
Active RN license (State License required)
BLS Certification
Recent Acute Care Case Management/Discharge Planning experience
Strong interdisciplinary communication and care coordination skills
Experience working with inpatient utilization review and discharge planning preferred
Shift: Days | 8:30 AM – 5:00 PM | 40 hours/week"

Medlivo Job ID #KAISJP00253470. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined.

About Medlivo


Benefits
  • Dental benefits
  • Vision benefits
  • 401k retirement plan
  • Health Care FSA
  • Life insurance
  • Sick pay
  • Holiday Pay
  • Medical benefits

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