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Remote Hca Utilization Review Jobs in Georgia (NOW HIRING)

Monogram Health

Market Physician Executive

Savannah, GA · Remote

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

EVERSANA

Regional Diagnostic Director

Atlanta, GA · On-site +1

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

EVERSANA

Regional Diagnostic Director

Atlanta, GA · Remote

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

Eversana

Regional Diagnostic Director

Atlanta, GA · Remote

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

Huntington

CRE Portfolio Manager I

Atlanta, GA · On-site +1

Manages delinquencies, collateral exceptions, borrowing base, portfolio reviews, specialized ... Effective utilization of IT systems that support the Commercial Segment. Systems include; CLOS ...

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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.

PBM Sr. Strategic Account Executive Remote

UnitedHealth Group

Atlanta, GA • On-site, Remote

Full-time

Retirement

Re-posted 24 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 893 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Sr. Strategic Account Executive is an individual contributor role serving as the senior - level liaison to assigned client accounts. Responsible for developing client trend management strategies, retaining, and growing assigned clients, cultivating multi-level client relationships, and managing staff.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Managing assigned accounts with a focus on client trend management, strategic plan development and execution, cultivating multi-level client relationships and management staff
  • Managing client contract renewal activities with the primary goals of retaining client, obtaining multiple-year agreements and maintaining or improving profitability
  • Maintaining consistent and regular client communications. Preparing and presenting regular client performance reviews, including identification of cost drivers, recommendations for cost savings opportunities, utilization and cost reports
  • Prioritizes and conducts regular on - site or telephonic client meetings as appropriate to proactively review client benefits, drug utilization and trend management strategies
  • Ensure that all client specific requirements are met including but not limited to (1) maintaining documentation of most current benefit designs, including exclusions, inclusions, formularies and co - pay structures and that information is accessible to Customer Service Pharmacy Technicians; (2) documenting plan change requests from clients and obtains appropriate approval, updates the Benefit Design Summary on the web, and confirms the plan change is completed and accurate; (3) following all audit requirements. Reviews Benefit Design Summary documents at least annually with clients and receives appropriate client signature approval
  • Maintaining a complete understanding of client contract terms including but not limited to the monitoring and reporting of performance guarantees. Ensuring that all assigned contracts are monitored and reported as stated in the terms
  • Developing strategies for staff development and retention
  • Cultivating in - group growth through these relationships
  • Staying abreast of industry trends and developments and demonstrating solid communication skills in presenting these to clients and staff
  • Demonstrating expertise in pharmacy benefit strategies and clinical programs
  • Supervising and assisting in the development of client specific implementation plans and managing overall client implementations
  • Providing leadership to client services team members in departmental and corporate initiatives
  • Providing regular feedback to management team regarding client requirements and business development opportunities
  • Participating in sales preparation meetings and finalist sales presentations as necessary
  • Ensuring quick response and follow - up to client inquiries, including returning phone calls and emails within 2 hours and attempted resolution of all issues in less than 48 hours
  • Follows - up with client within 24 hours after issue resolution
  • Regularly attending and actively participating in company meetings as requested
  • Participating as preceptor / mentor to new staff as requested. Assisting in the development of ongoing training topics and materials for staff
  • Following all policies and procedures relating to job responsibilities and participates in the development and maintenance of departmental policies and procedures for Client Services, as appropriate
  • Performing other duties as assigned to meet corporate objectives
  • Providing support to other departments as requested

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • 4+ years of strategic PBM client account and contract management
  • 2+ years of experience in the Health Plan Commercial Market
  • Understanding of pharmacy benefit strategies and pricing practices
  • Advanced proficiency in delivering presentations to various audiences
  • Proficient with MS suite - Word, Excel, PowerPoint
  • Proven ability to handle complex client issues
  • Proven solid PBM business and financial acumen
  • Demonstrates a high degree of client focus and attention to service
  • Proven excellent negotiation skills
  • Ability to travel up to 25% of the time

Preferred Qualifications:
  • 1+ years PBM Medicaid client management experience
  • Project Management Experience/Certification
  • 3+ years of experience with upsell programs to clients
  • 2+ years of PBM operations experience
  • Familiarity with RxClaim; Tracker and Navigator

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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