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Remote Utilization Management Jobs in Georgia (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Lawrenceville, GA · On-site +1

$49.50 - $60.25/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Atlanta, GA · On-site +1

$55 - $67/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management ... The Alpharetta, GA candidate will also have the ability to work remote. This is an inbound ...

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Remote Utilization Management information

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$18

$35

$58

How much do remote utilization management jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for remote utilization management in Georgia is $35.70, according to ZipRecruiter salary data. Most workers in this role earn between $28.22 and $41.01 per hour, depending on experience, location, and employer.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

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

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Georgia? The most popular types of Utilization Management jobs in Georgia are:
What are popular job titles related to Remote Utilization Management jobs in Georgia? For Remote Utilization Management jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Georgia look for? The top searched job categories for Remote Utilization Management jobs in Georgia are:
What cities in Georgia are hiring for Remote Utilization Management jobs? Cities in Georgia with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Georgia as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $74,260 per year, or $35.7 per hour.
Utilization Management Specialist

Utilization Management Specialist

Advantage Behavioral Health Systems

Athens, GA • On-site, Remote

$45K - $48K/yr

Full-time

Posted 12 hours ago

Job description

Schedule:
Monday through Friday 8:00 AM - 4:30 PM
Position Summary:
Under general supervision, performs complex administrative duties and statistical, financial, or operations data analysis and reporting in support of management decision making within the functional area. Identifies trends, discrepancies and variances to improve the efficiency and effectiveness of operations. May partner with other departments, divisions, outside agencies, and vendors to address business issues. Exercises various latitudes of independent judgement. May administer or provide high level support for various projects, grants, contracts, implementation of procedures and/or any specialized functions. Assists with orientation, training, or providing task guidance of junior team members.
Job Responsibilities and Performance Standards:
  • Processes and answers Sys Aid Tickets regarding authorizations and write-off requests as submitted by staff
  • Runs daily, monthly, quarterly reports including but not limited to expiring auths, no auths, registrations lapsed, CMO requests, Void status, Pend status, KPI dashboard (CMO & VA)
  • Research and works on reports for correction and trends, communicating actions and trends to programs and supervisors
  • Monitors Care Management Auth email for authorization manual uploads and 15-day report from Carelon
  • Monitors CMO/Medicare Teams Chat
  • Submits Requests for Services onto the HealthShare Referral Manager (HRSM) system for VA clients
  • Monitors HealthShare Referral Manager (HRSM) for tasks assigned from VA, uploads required documentation for VA clients
  • Coordinates with Centralized Scheduling for new VA referrals and kept appointments
  • Submits Outpatient Treatment Requests on GAMMIS portal
  • Downloads approved authorizations from GAMMIS portal
  • Batches and loads ASO authorization requests and response files
  • Completes concurrent ASO authorization requests for Outpatient clinics
  • Research and works rejections from ASO, CMO, and VA authorization requests
  • Collaborate with Care Management Department staff for clinical review and guidance with authorization requests, rejections, denials, etc.
  • Tracks Women's Residential and Transition Registrations and Authorizations.
  • Other duties as assigned.

Minimum Qualifications:
  • High school diploma or GED AND 2 years of experience required at the lower-level position or position equivalent.
  • Must show ability to lead and supervise a team.

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