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Remote Utilization Management Nurse Jobs in Decatur, GA

IQVIA

Flex Nurse Educator

Atlanta, GA · Remote

Deliver remote patient education, including medication administration training and adherence ... Nurse Educators do not provide medical advice but empower patients to manage their disease and ...

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All JobsUtilization Management Nurse JobsRemote Utilization Management Nurse JobsRemote Utilization Management Nurse Jobs in Decatur, GA

Remote Utilization Management Nurse information

See Decatur, GA salary details

$20

$41

$67

How much do remote utilization management nurse jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for remote utilization management nurse in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What is a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

What are the key skills and qualifications needed to thrive as a remote utilization management nurse?

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.

What is the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

More about Remote Utilization Management Nurse jobs

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The most popular types of Utilization Management Nurse jobs in Decatur, GA are:

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For Remote Utilization Management Nurse jobs in Decatur, GA, the most frequently searched job titles are:

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What cities near Decatur, GA are hiring for Remote Utilization Management Nurse jobs?

Cities near Decatur, GA with the most Remote Utilization Management Nurse job openings:

Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Decatur, GA as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, 2% Temporary, and 3% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.

Clinical Director BCBA- Remote

Alpharetta, GA • Remote

Alpha & Omega Kids Developmental Services
See more jobs at Alpha & Omega Kids Developmental Servicesexternal

$90K - $100K/yr

Full-time

Posted 11 days ago

Job description

Clinical Director BCBA Role -NYC Full Time 

The Clinical Director ensures the consistent delivery of clinically sound, ethical, and evidence-based services

while maintaining compliance, operational efficiency, and staff development across assigned region(s). This position carries

ultimate responsibility for clinical soundness, documentation compliance, and overall quality of service delivery within the

assigned regions.

Salary: $90,000-$100,000

Essential Functions

Provide clinical oversight and leadership for ABA services within assigned regions, ensuring fidelity to AOK’s clinical,

ethical, and operational standards.

Oversee BCBA and RBT caseload distribution, productivity, and utilization, maintaining alignment with payer

authorizations and KPI targets.

Monitor and enforce same-day session note completion and conversion, ensuring documentation accuracy and

timeliness for all staff. Collaborate with Scheduling and Training to resolve delays and implement real-time coaching

when deficiencies are identified.

Design, implement, and maintain clinical documentation templates, treatment plan frameworks, and audit-ready

workflows in CentralReach.

Collaborate with the Training & Development Manager to ensure comprehensive clinical onboarding, competency

assessments, and continued education for all clinical and support staff.

Develop and track clinical outcome measures that evaluate treatment effectiveness, service consistency, and caregiver

engagement.

Supervise and mentor BCBAs, providing feedback on treatment integrity, documentation quality, and professional

growth.

Collaborate with the Vice President of Clinical Operations and Scheduling to ensure efficient client coverage, minimal

cancellations, and high service utilization.

Conduct regular documentation audits and case reviews to verify adherence to clinical and compliance standards.

Lead monthly BCBA team meetings to reinforce accountability for session note timeliness, attendance accuracy, and

same-day conversion expectations.

Collaborate with Talent Acquisition, HR, and Onboarding to align workforce planning and clinical capacity with growth

targets.

Foster a culture of compliance, collaboration, and clinical excellence that embodies AOK’s core values

of Stewardship (heart), Impact (purpose), Ingenuity (mind), Mastery (excellence), Advocacy (action).

Key Responsibility Areas

40% Clinical Oversight & Quality Assurance

Supervise clinical documentation, treatment quality, and same-day session note conversion rates across regions.

30% Leadership & People Development

Coach and mentor BCBAs, ensuring effective supervision and team development.

30% Clinical Responsibilities

Be responsible for carrying and maintaining a small clinical caseload with IA's. At AOK, we believe that a strong clinical leader will always lead by example and keep clinical skills sharp and in line with current industry standards and trends.

Collaboration & Stakeholders

Works closely with the President of the ABA Division, Vice President of Compliance, Scheduling, Training, and Operations

teams to align regional goals, staffing models, and compliance systems. Partners with BCBAs, RBTs, and administrative

leadership to ensure consistent service quality and strong client outcomes.

Qualifications

Board Certified Behavior Analyst (BCBA) required; Licensed Behavior Analyst (LBA) required in applicable states.

Master’s degree in Applied Behavior Analysis, Psychology, Education, or related field.

Minimum of 5 years of clinical experience, including at least 3 years in a leadership capacity.

Demonstrated success managing home-based ABA operations.

Strong understanding of insurance requirements, payer compliance, and audit preparedness.

Proficiency in CentralReach or equivalent EHR and data systems.

Exceptional leadership, communication, and analytical skills.

Ability to lead teams through growth, expansion, and organizational change with professionalism and composure.

Travel & Work Conditions

Hybrid-remote role with regional travel required for clinical observations, and leadership meetings. Evening or weekend

availability may occasionally be required for urgent matters or regional events.

Key Performance Indicators (KPIs)

Performance Area Target / Expectation

Clinical Documentation

Compliance

100% documentation audit compliance and payer readiness across assigned regions

BCBA & RBT Utilization ≥90% utilization relative to authorized hours

Session Note Conversion ≥99% same-day session note conversion barring technical or system errors

Client Cancellations ≤15% cancellation rate across all regions

Onboarding & Staffing

Timeliness

All new hires trained and scheduled within one week of onboarding completion

Staff Retention &

Engagement

Positive BCBA and RBT retention and engagement rates

Billable Minimum (Growth

Phase) Maintenance of up to 50 monthly billable hours

Clinical Outcomes &

Family Satisfaction

Demonstrated improvement in treatment outcome metrics and family satisfaction survey

results

Leadership & Department

Collaboration

Active participation in cross-departmental initiatives; consistent communication with

Scheduling and Training to prevent workflow delay

This is full time role.