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Remote Optum Utilization Review Jobs in Georgia (NOW HIRING)

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.

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Remote Optum Utilization Review information

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review nurse?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What are the most commonly searched types of Optum Utilization Review jobs in Georgia? The most popular types of Optum Utilization Review jobs in Georgia are:
What are popular job titles related to Remote Optum Utilization Review jobs in Georgia? For Remote Optum Utilization Review jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Georgia look for? The top searched job categories for Remote Optum Utilization Review jobs in Georgia are:
What cities in Georgia are hiring for Remote Optum Utilization Review jobs? Cities in Georgia with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Full-Time CORE Assistant Clinical Director

Georgia Families in Transition

Decatur, GA • On-site, Remote

$80K/yr

Full-time

Re-posted 6 days ago

Job description

Georgia Families in Transition, LLC
Position Title: Full-Time Assistant Clinical Director (CORE Program)
Location: Fully Remote (Georgia Residents Only)
Reports To: Executive Director
Classification: 1099 Independent Contractor
Compensation: $80,000 Annually
Location: Fully Remote (Georgia Residents Only)
Employment Type: Full-Time (40 Hours Per Week)
Schedule: (Monday-Friday: 9am-6pm)
About Georgia Families in Transition
Georgia Families in Transition (GFIT) is a community-based behavioral health organization dedicated to providing high-quality services that promote stability, recovery, and positive outcomes for children, adolescents, adults, and families. Our CORE Program provides outpatient behavioral health services designed to strengthen individuals and families through therapy, skills training, care coordination, and community support.
We are seeking a highly motivated and experienced Assistant Clinical Director to provide clinical leadership, staff supervision, quality assurance oversight, and crisis support for our CORE Program.
Position Summary
The Assistant Clinical Director provides direct clinical oversight and operational support to the CORE Program by ensuring quality service delivery, regulatory compliance, staff development, client retention, and crisis management. This leadership position plays a critical role in supporting clinicians and paraprofessionals while maintaining high standards of clinical care and documentation.
The Assistant Clinical Director will work closely with the Executive Director to monitor program performance, strengthen staff accountability, improve client outcomes, and ensure compliance with DBHDD, Medicaid, and organizational requirements.
Essential Duties and Responsibilities
Clinical Leadership & Oversight
  • Provide ongoing clinical leadership, consultation, and support to therapists and paraprofessionals.
  • Promote high-quality, ethical, and compliant service delivery throughout the CORE Program.
  • Review and approve clinical documentation, including assessments, treatment plans, progress notes, discharge summaries, and other required records.
  • Ensure services are delivered in accordance with DBHDD standards, Medicaid requirements, and organizational policies.
  • Collaborate with the Executive Director to identify training needs, documentation concerns, and performance improvement opportunities.
  • Assist with implementation of clinical initiatives, staff accountability measures, and quality improvement projects.

Crisis Documentation & Compliance
  • Ensure all clinical staff complete crisis documentation accurately, thoroughly, and within required timeframes.
  • Review crisis documentation practices and identify opportunities for improvement.
  • Develop and implement corrective action plans when crisis documentation concerns are identified.
  • Monitor crisis response activities to ensure compliance with agency, DBHDD, and Medicaid requirements.
  • Provide guidance and oversight related to safety planning, crisis intervention, and risk management.

Caseload & Productivity Management
  • Monitor and manage clinician caseloads to ensure equitable distribution of clients and services across the clinical team.
  • Review staff productivity, service utilization, and caseload capacity on a regular basis to maintain operational efficiency.
  • Monitor client engagement, attendance, and service frequency to support positive outcomes and retention.
  • Assist in developing strategies to improve productivity while maintaining quality care standards.

Quality Assurance & Performance Improvement
  • Review Quality Assurance (QA) Call Tracker reports regularly to identify trends, service concerns, client satisfaction issues, and opportunities for improvement.
  • Analyze feedback received from clients, parents, guardians, referral sources, and stakeholders.
  • Assist in resolving concerns in a timely, professional, and clinically appropriate manner.
  • Conduct chart reviews and documentation audits to ensure compliance and quality service delivery.
  • Develop and implement performance improvement initiatives when needed.

Client Retention & Discharge Review
  • Review and verify all discharge requests submitted by clinical staff to ensure they are clinically appropriate, justified, and supported by required documentation.
  • Review cases at risk of discharge and collaborate with clinicians, clients, parents, and guardians to identify barriers to treatment.
  • Recommend interventions and alternative service options to support continued engagement whenever clinically appropriate.
  • Support staff in addressing attendance concerns, family engagement challenges, and service barriers.

Staff Supervision & Development
  • Conduct weekly individual supervision sessions with CORE therapists and paraprofessionals.
  • Facilitate monthly group supervision meetings to promote collaboration, skill development, and clinical excellence.
  • Provide coaching, mentorship, and ongoing support to strengthen staff performance and professional growth.
  • Maintain accurate supervision documentation in accordance with DBHDD and agency requirements.
  • Assist with onboarding, training, and staff development initiatives.

Crisis Support & On-Call Responsibilities
  • On call as clinical support for crisis calls from mental health professionals.
  • Provide clinical direction related to crisis intervention, de-escalation, safety planning, hospitalization, and emergency response.
  • Ensure timely communication of all after-hours incidents to the Executive Director, including recommendations and follow-up actions.
  • Support staff in managing high-risk situations while ensuring client and community safety.

Qualifications
Required
  • Master's Degree in Counseling, Social Work, Psychology, Marriage and Family Therapy, or a related behavioral health field.
  • Active, unrestricted Georgia licensure as an LPC, LCSW, LMFT, or equivalent independent clinical license.
  • Minimum three (3) years of clinical experience in community-based or outpatient behavioral health settings.
  • Minimum two (2) years of supervisory, leadership, or management experience.
  • Strong knowledge of DBHDD regulations, Medicaid standards, behavioral health documentation requirements, and quality assurance practices.
  • Experience supervising clinicians and/or paraprofessionals.
  • Excellent written, verbal, organizational, leadership, and problem-solving skills.
  • Experience reviewing clinical documentation, productivity, caseload management, and compliance standards.

Preferred
  • Experience in community-based behavioral health programs.
  • Experience with quality assurance reviews, audits, utilization management, and staff performance improvement.
  • Experience working with children, adolescents, adults, and families.
  • Experience managing crisis situations and high-risk behavioral health populations.

Employment Classification
This is a Full-Time 1099 Independent Contractor position requiring approximately 40 hours per week.
While classified as an independent contractor role, the Assistant Clinical Director is expected to maintain a consistent Monday-Friday schedule, participate in required meetings and supervision activities, provide leadership and support to staff, and participate in after-hours crisis coverage as assigned.
The selected candidate will be responsible for all applicable federal, state, and local taxes associated with independent contractor status.
Additional Requirements
  • Must reside in Georgia.
  • Must maintain an active, unrestricted Georgia professional license.
  • Must have reliable internet access and a private workspace suitable for confidential clinical and supervisory activities.
  • Must be available to participate in an after-hours on-call rotation.
  • Must successfully pass all required background screenings and credentialing requirements.

Why Join GFIT?
  • Fully Remote Leadership Position
  • Competitive Annual Compensation
  • Opportunity to Influence Clinical Quality and Program Growth
  • Supportive Leadership Team
  • Meaningful Work Serving Children, Families, and Communities Throughout Georgia
  • Opportunity for Advancement Within a Growing Behavioral Health Organization

Georgia Families in Transition is an Equal Opportunity Contractor and values diversity, professionalism, and excellence in service delivery.

Apply