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Remote Hca Utilization Review Jobs in Georgia (NOW HIRING)

Monogram Health

Market Physician Executive

Atlanta, GA · Remote

Review and approve APP, RN, SW, and PharmD plans of care. * Provide direct and indirect patient ... This position will be remote within the designated market with occasional in-home patient treatment ...

Raymond

Electrical Engineering Department Head

Conyers, GA · On-site +1

$97K - $125K/yr

... Remote (Hybrid options available) About Raymond: We are a progressive, forward-thinking ... Monitor and manage departmental workload, utilization, staffing assignments, and resource planning.

FormativGroup

Cloud Solution Architect

Atlanta, GA · Remote

$61 - $83.75/hr

Support hands-on delivery as needed, including Salesforce configuration, data loads, and review of ... Proven leadership of Salesforce delivery teams, including onshore/offshore models, remote teams ...

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Remote Hca Utilization Review information

What is the difference between Remote Hca Utilization Review vs Remote Hca Case Manager?

AspectRemote Hca Utilization ReviewRemote Hca Case Manager
CredentialsTypically requires healthcare-related certifications, such as RN or licensed healthcare professionalOften requires RN, social work, or case management certifications
Work EnvironmentPrimarily reviewing medical necessity and insurance coverage remotelyManaging patient cases, coordinating care, and discharge planning remotely
Employer & Industry UsageUsed by health insurance companies, healthcare providers, and utilization review organizationsEmployed by hospitals, insurance companies, and healthcare organizations

Remote Hca Utilization Review focuses on assessing medical necessity and insurance coverage, while Remote Hca Case Managers handle patient care coordination and discharge planning. Both roles require healthcare credentials and are integral to healthcare management, but they differ in daily responsibilities and focus areas.

How do I get into a remote HCA utilization review?

To become a remote HCA utilization review specialist, candidates typically need a healthcare background such as nursing or medical coding, along with knowledge of insurance policies and medical terminology. Relevant certifications like Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can improve job prospects. Employers often require prior experience in medical review or utilization management and proficiency with electronic health record (EHR) systems, with many roles offering flexible or remote schedules.

Is remote HCA utilization review work from home?

Remote HCA utilization review jobs are often performed from home, allowing reviewers to assess healthcare claims and authorizations remotely. These roles typically require familiarity with healthcare software, strong communication skills, and adherence to confidentiality standards. Many employers offer flexible or fully remote schedules for this position.

What are popular job titles related to Remote Hca Utilization Review jobs in Georgia?

For Remote Hca Utilization Review jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Remote Hca Utilization Review jobs in Georgia look for?

The top searched job categories for Remote Hca Utilization Review jobs in Georgia are:

What cities in Georgia are hiring for Remote Hca Utilization Review jobs?

Cities in Georgia with the most Remote Hca Utilization Review job openings:

Remote Hca Utilization Review jobs near you
Infographic showing various Remote Hca Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 6% In-person, and 94% Remote job distribution.

Market Physician Executive

Monogram Health

Atlanta, GA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Monogram Health is seeking a mission-driven Market Physician Executive (MPE) to lead its in-home multi-specialty polychronic care model within an assigned market. This role focuses on improving patient well-being, quality of life, and health outcomes by leveraging proprietary AI algorithms and a risk-based model. The MPE will contribute to developing and overseeing clinical strategies, policies, and operations to drive improved patient health outcomes, aligning with the quadruple AIM.

Practice Info

  • Lead an in-home multi-specialty polychronic care model in an assigned market.
  • Each market comprises 5-10 practices led by local APPs, RNs, LCSWs, and pharmacists.
  • Collaborate with Monogram Health's Multi-Specialty Platform to leverage employed specialists for in-home specialty care.
  • Deploy a proven risk-based model to ensure health equity and equality using proprietary next-generation AI algorithms.
  • Report to the Region President as a key clinical leader within Monogram Health.

Responsibilities

  • Know, understand, and deliver on Monogram Health's proprietary evidenced-based clinical pathways.
  • Review and approve APP, RN, SW, and PharmD plans of care.
  • Provide direct and indirect patient care, including diagnosis and treatment of disease.
  • Engage with patients on treatment plans, community provider collaboration, and direct evidence-based care pathways.
  • Order labs, referrals, and complete actions to drive patient outcomes, close care gaps, and Clinical Intervention closure.
  • Provide clinical guidance and direction to Market teams to drive Population Health Management activities.
  • Collaborate with Medical Economics, Finance, and other stakeholders to root cause and action against utilization trends.
  • Participate in Monogram On-Call activities, with a minimum of 7 days on call once per quarter.

Compensation

  • Competitive salary
  • Opportunity to participate in the company's bonus program

Benefits

  • Comprehensive medical, dental, vision and life insurance.
  • Flexible paid leave and vacation policy.
  • 401(k) plan with matching contributions.

Shift & Schedule

  • This position will be remote within the designated market with occasional in-home patient treatment visits and occasional domestic travel.
  • 7 days on call minimum once/quarter.

Requirements

  • Must be willing and able to obtain hospital privileges at required facilities.
  • Demonstrated experience applying evidence-based clinical criteria.
  • Experience in renal care and geriatrics.
  • Strong management and communication skills.
  • Active, unrestricted state medical license required in each state within the market.
  • Experience with high need Medicare Advantage and managed Medicaid populations.
  • Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment.
  • Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
  • Willingness to become licensed in multiple states.
  • MD or DO degree from an accredited medical school.
  • BC or BE in an ACGME approved specialty such as Nephrology, Internal Medicine, Family Practice, Emergency Medicine, Critical Care, Cardiology, Endocrinology, Hepatology, or Geriatrics.

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