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Medical Director Utilization Management Jobs in Decatur, GA

Gentiva Hospice

Medical Director

Stockbridge, GA · On-site

... directed care to hospice patients while upholding the highest standards of medical practice. You ... management. * Monitor pharmacy utilization, ensuring appropriate medication prescribing and ...

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Medical Director Utilization Management information

See Decatur, GA salary details

$12.7K

$226.9K

$348.6K

How much do medical director utilization management jobs pay per year?

As of Jun 4, 2026, the average yearly pay for medical director utilization management in Decatur, GA is $226,869.00, according to ZipRecruiter salary data. Most workers in this role earn between $193,300.00 and $277,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Director Utilization Management, and why are they important?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a Medical Director in Utilization Management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is a Medical Director Utilization Management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Decatur, GA? For Medical Director Utilization Management jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Medical Director Utilization Management jobs in Decatur, GA look for? The top searched job categories for Medical Director Utilization Management jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Medical Director Utilization Management jobs? Cities near Decatur, GA with the most Medical Director Utilization Management job openings:
Medical Director Utilization Management jobs near you
Director, Utilization Management

Director, Utilization Management

Emory Healthcare

Atlanta, GA • On-site

Full-time

Posted 12 days ago

Emory Healthcare rating

7.7

Company rating: 7.7 out of 10

Based on 209 frontline employees who took The Breakroom Quiz

161st of 865 rated healthcare providers

Job description

Overview
Be inspired. Be rewarded. Belong. At Emory Healthcare.
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
  • Comprehensive health benefits that start day 1
  • Student Loan Repayment Assistance & Reimbursement Programs
  • Family-focused benefits
  • Wellness incentives
  • Ongoing mentorship, development, and leadership programs
  • And more

Work Location: Atlanta, GA
Description
The Director of Utilization Management plays a pivotal role in our healthcare system by overseeing and optimizing the utilization of resources and services across our organization.
Utilization management includes, but is not limited to, analyzing entrance into care environments from multiple perspectives including payors, healthcare system, patient/family, and providers; ensuring appropriate and high quality care in the most appropriate setting and most appropriate cost; analyzing the effectiveness of treatment before, during and after care delivery; and, developing relationships with and educating payors, healthcare executives, patients and families, and providers.
This position is responsible for developing and implementing utilization management strategies that align with our commitment to high quality and safe care, outstanding patient experience, cost-effectiveness, and regulatory compliance.
Strategic Planning:
  • Develop and execute utilization management strategies that align with the organization's mission, vision, and values
  • Collaborate with senior leadership to establish short-term and long-term objectives

Team Leadership:
  • Lead and manage a team of utilization management professionals, including nurses, case managers, and analysts, to ensure efficient and effective utilization of resources

Utilization Review:
  • Implement systemwide utilization review processes and policies to assess the appropriateness of healthcare services, medical treatments, and length of stay
  • Make recommendations for adjustments as needed

Quality and Process Improvement:
  • Collaborate with the Office of Quality to continuously improve care delivery processes and outcomes
  • Ensure adherence to quality standards and regulations

Operational Efficiency:
  • Develop and monitor utilization management programs that control internal and external costs without compromising the quality of care, making data-driven decisions to reduce unnecessary resource utilization

Data Analysis:
  • Utilize data and analytics to identify trends, opportunities for improvement, and areas where resource utilization can be optimized
  • Educate direct reports in utilization of data and analytics to drive performance improvement
  • Regularly report findings and recommendations to the executive team

Regulatory Compliance:
  • Stay informed about healthcare regulations and reimbursement policies, ensuring that the organization complies with all relevant laws and guidelines
  • Ensure that each direct report is aware of these and practices the same

Interdepartmental Collaboration:
  • Foster effective communication and collaboration with various departments, including medical staff, finance, nursing, and administration, to ensure seamless utilization management

Education and Training:
  • Provide training and education to staff members regarding utilization management processes, policies, and best practices

Reporting: Prepare and present regular reports to senior leadership on utilization management initiatives, outcomes, and performance indicators
Required Minimum Qualifications:
  • Masters degree in healthcare management, nursing, or a related field
  • Valid healthcare administration license or certification (e.g., Registered Nurse, Certified Professional in Healthcare Management)
  • Proven leadership experience in utilization management or a related field within the healthcare industry
  • In-depth knowledge of healthcare regulations, insurance, and reimbursement policies
  • Strong analytical, problem-solving, and data-driven decision-making skills
  • Excellent interpersonal, communication, and presentation skills
  • Ability to lead, motivate, and develop a high-performing team
  • Strong project management, process improvement, and organizational skills

JOIN OUR TEAM TODAY! Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.
Additional Details
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

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