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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 ...

Elevance Health

Medical Director - Surgery

Atlanta, GA · On-site

Medical Director - Surgery Location: This role enables associates to work virtually full-time, with ... Experience with utilization management, especially with CMS guidelines preferred. * Preferred board ...

MedElite Group, LLC.

Travel Medical Director

Atlanta, GA

$250K - $300K/yr

Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most ... Review clinical outcomes, quality metrics, and utilization data to drive continuous improvement

Elevance Health

Medical Management Nurse

Atlanta, GA · On-site

Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse ... Utilization Management highly preferred Job Level: Non-Management Exempt Workshift: Job Family ...

Elevance Health

Medical Management Nurse

Atlanta, GA · On-site

Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse ... Utilization Management highly preferred Please be advised that Elevance Health only accepts resumes ...

Elevance Health

Med Mgmt Nurse (US)

Atlanta, GA · On-site

$83K - $131K/yr

Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse ... Utilization management experience. * Strong of computer skills. For candidates working in person or ...

Elevance Health

Associate Medical Director

Atlanta, GA · On-site

$188K - $294K/yr

Associate Medical Director Clinical Operations Associate Medical Director Carelon Medical Benefits Management Radiology Benefit Management/Utilization Review Virtual : This role enables associates to ...

Elevance Health

Associate Medical Director

Atlanta, GA · On-site

$188K - $294K/yr

Clinical Operations Associate Medical Director Carelon Medical Benefits Management Radiology Benefit Management/Utilization Review Virtual : This role enables associates to work virtually full-time, ...

VCA Animal Hospital

Medical Director

Marietta, GA · On-site

Join us as a Medical Director at VCA Terrell Mill Animal Hospital, and you'll quickly discover that ... Management reserves the right to revise the or require that other tasks be performed when the ...

Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Monitor patient length of stay and extensions and inform clinical and medical staff on issues that ...

Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Act as liaison between managed care organizations and the facility professional clinical staff ... Monitor patient length of stay and extensions and inform clinical and medical staff on issues that ...

Devereux

Medical Director

Kennesaw, GA · On-site

Being a Medical Director at Devereux has its Advantages You will work with other dedicated ... managing psychiatry team, implementation of clinical best practices and program development.

Devereux

Medical Director

Kennesaw, GA

Being a Medical Director at Devereux has its Advantages You will work with other dedicated ... Experience managing psychiatry team, implementation of clinical best practices and program ...

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All JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Decatur, GA

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 Jul 2, 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

Medical Director - (Fulton County) - 00059561

Department of Human Services

Atlanta, GA • On-site

Full-time

Posted 25 days ago

Job description

Company Description
The Georgia Department of Human Services (DHS) provides a wide range of human services designed to
promote self-sufficiency, safety and well-being for all Georgians. The department is one of the largest agencies in state government with an annual budget of $1.8 billion and nearly 9,000
employees. DHS is comprised of three Divisions: the Division of Aging Services, the Division of Child
Support Services, and the Division of Family and Children Services.
Job Description
The Office of the Commissioner, is seeking candidates for the position of Medical Director. This position is based at 2 Peachtree Street in Atlanta, GA, in Fulton County. The Medical Director leads the development and oversight of an integrated system-level strategy for delivering medical consultation services for the Georgia Department of Human Services, with an emphasis on the Divisions of Family and Children Services (DFCS) and Aging Services (DAS).
Job Summary & Responsibilities:
The Medical Director will report to the DHS Commissioner with a dotted line to the Director of the Division of Family and Children Services. This position will also collaborate with the Division of Aging
Services leadership teams to meet system-wide goals and objectives, with
particular emphasis on:
  • Leadership and/or participation in institutional
    initiatives and programs on patient safety, quality of care, performance
    improvement, patient access, patient flow, patient capacity, value, resource
    utilization, patient experience, and business development.
  • Integration of adult and children's care with key
    institutional operational and service goals and initiatives, including patient
    safety, quality of care, performance improvement, patient access, patient flow,
    patient capacity, value, resource utilization, and patient experience across
    the continuum of care.
  • Provides leadership in all medical consultations
    concerning adults and children in the Division of Aging Services and Division of
    Family and Children Services, to include
    services for children in care and wards of the State.
  • Participation in and organization of
    various task forces and committees to review levels of care and services
    provided.
  • Oversight of clinical delivery model for inpatient,
    operative, and outpatient services.
  • Assuring provision of timely, appropriate patient access
    to inpatient, operative, and outpatient services.
  • Development of goals, objectives, measures, strategy, and
    plan for inpatient, operative, and outpatient services.
  • Provides medical direction of staffing models, provider
    schedules, provider work assignments, policies and procedures, quality
    assurance, performance improvement, clinical guidelines, resource utilization,
    fixed asset management, professional documentation and coding in inpatient,
    operative, and outpatient services.
  • Referral management, including oversight and coordination
    of referrals to specialists.
  • Integration of adult's and children's care with health
    plan referral authorization processes.
  • Assuring compliance with institutional and regulatory
    requirements.

Qualifications
Preference will be given to candidates who, in addition to meeting the minimum qualifications, demonstrate some or all of the following skills/experience:
  • Must have an MD or DO degree with a minimum of 5 years of
    experience in clinical practice. Clinical experience in a pediatrics or
    gerontology is preferred.
  • Requires current Georgia medical license and board
    certification in area of specialization. It is recognized that a
    physician executive may be unable to maintain board certification after several
    years of full time administrative duties; however, initial board certification
    in a specialty relevant to specialty care after completion of formal graduate training
    is required.
  • Must have medical leadership experience, preferably as
    Medical Director in a health care or social services facility.
  • Must have the demonstrated ability to respond creatively
    to a changing healthcare or social services marketplace and improve patient
    access, the quality of care, and patient experience in market-competitive
    environment.
  • Experience with the use of psychotropic drugs, especially for children.

Additional Information
To apply for this position please apply by visiting: https://ga.taleo.net/careersection/ga_external/jobdetail.ftl?job=HEA01GC

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