Atlanta, GA · On-site
$120 - $160/hr
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Atlanta, GA · On-site
$120 - $160/hr
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ...
Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ...
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
ResponsibilitiesProvide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
ResponsibilitiesProvide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Atlanta, GA · On-site
$110 - $170/hr
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Atlanta, GA · On-site
$110 - $170/hr
Responsibilities Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and ...
Alpharetta, GA · On-site
Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Stay current with healthcare regulations, payer policies, and evidence-based clinical guidelines.
Alpharetta, GA · On-site
Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Stay current with healthcare regulations, payer policies, and evidence-based clinical guidelines.
Atlanta, GA · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...
Quick apply
Atlanta, GA · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... We're on a mission to change health care -- an experience made whole by our unique backgrounds and ...
Augusta, GA · On-site
... Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is ...
Augusta, GA · On-site
... Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is ...
Augusta, GA · On-site
... Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is ...
Augusta, GA · On-site
... Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is ...
Decatur, GA · On-site
Strong communication, attention to detail, and knowledge of behavioral health services are ... utilization reviews, determinations, and communications in the electronic medical record (EMR ...
Decatur, GA · On-site
Strong communication, attention to detail, and knowledge of behavioral health services are ... utilization reviews, determinations, and communications in the electronic medical record (EMR ...
Decatur, GA · On-site
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
Decatur, GA · On-site
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Augusta, GA · On-site
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case ... One of the nation's largest and most respected providers of hospital and healthcare services ...
Decatur, GA · On-site
The Utilization Review Specialist coordinates insurance authorizations for individual therapy and ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
Decatur, GA · On-site
The Utilization Review Specialist coordinates insurance authorizations for individual therapy and ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Strong communication, attention to detail, and knowledge of behavioral health services are ...
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 ...
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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 ...
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... One of the nation's largest and most respected providers of hospital and healthcare services ...
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... One of the nation's largest and most respected providers of hospital and healthcare services ...
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... One of the nation's largest and most respected providers of hospital and healthcare services ...
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will ... One of the nation's largest and most respected providers of hospital and healthcare services ...
An Optum Health Utilization Review job involves assessing medical necessity, appropriateness, and efficiency of healthcare services. Professionals in this role review patient records, insurance claims, and treatment plans to ensure compliance with industry standards and policies. They collaborate with healthcare providers, insurance companies, and patients to optimize care while managing costs. The position requires strong clinical knowledge, attention to detail, and familiarity with medical guidelines. It plays a crucial role in improving healthcare quality and reducing unnecessary expenses.
To excel in an Optum Health Utilization Review role, you typically need a background in nursing or a related clinical field, a valid RN license, and familiarity with healthcare policies and guidelines. Experience with utilization management software, electronic medical records (EMR) systems, and potentially certifications such as CCM (Certified Case Manager) are highly valued. Strong analytical skills, attention to detail, and effective communication are important soft skills for evaluating medical necessity and collaborating with providers. These competencies ensure accurate, compliant review processes that support optimal patient care and organizational efficiency.
Optum Health Utilization Review specialists often encounter challenges such as staying current with frequently changing healthcare regulations, handling complex medical cases, and managing high caseloads with tight deadlines. The team fosters a collaborative environment where members can consult with medical directors, other clinical reviewers, and support staff to resolve difficult cases and clarify policies. Regular training sessions, ongoing education, and access to up-to-date resources help team members stay informed and manage these challenges effectively. This supportive structure enables specialists to maintain high accuracy and efficiency while delivering quality outcomes for patients and providers.
The most popular types of Optum Health Utilization Review jobs in Georgia are:
For Optum Health Utilization Review jobs in Georgia, the most frequently searched job titles are:
The top searched job categories for Optum Health Utilization Review jobs in Georgia are:
Cities in Georgia with the most Optum Health Utilization Review job openings:
$120 - $160/hr
Other
Posted 23 days ago
Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance. Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations.
Piedmont Healthcare Corporate
