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Remote Utilization Management Jobs in Georgia (NOW HIRING)

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 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

Phoebe Putney Health System

... Utilization review duties in Care Management. Timely communication of clinical information and updates will be provided to the insurance companies as requested or required by contract or federal and ...

Monogram Health

Market Physician Executive

Savannah, GA · Remote

... utilization, pharmacological prescribing and therapy management, multi-specialty platform, and ... This position will be remote within the designated market with occasional in-home patient treatment ...

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Remote Utilization Management information

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 July 2026, with employment types broken down into 83% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Utilization Management Director - RN Required - Remote

Utilization Management Director - RN Required - Remote

Northeast Georgia Health System

Gainesville, GA • On-site, Remote

Full-time

Posted 17 days ago

Northeast Georgia Health System rating

7.3

Company rating: 7.3 out of 10

Based on 152 frontline employees who took The Breakroom Quiz

305th of 890 rated healthcare providers

Job description

Job Category:
Executive Leadership, Revenue Cycle
Work Shift/Schedule:
8 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
The Director of Utilization Management (UM) is responsible for leading and managing the Utilization Management (UM) functions at Northeast Georgia Medical Center. This position plays a critical role in ensuring correct status assignment, optimizing reimbursement, minimizing denials, improving case mix index (CMI), and ensuring appropriate utilization of hospital resources. The Director works collaboratively with hospital leadership, physicians, case management, finance, and compliance teams to enhance quality reporting, patient outcomes, and financial integrity. This role serves as a key liaison between clinical and financial operations, ensuring a seamless integration of documentation integrity with utilization management to drive efficiency, compliance, and revenue cycle optimization.
Minimum Job Qualifications
  • Licensure or other certifications: Registered Nurse, UR specific certification preferred (CCM, ACM, CPUR)
  • Educational Requirements: Bachelors Degree
  • Minimum Experience: Minimum of 7 years UR with progressive Revenue Cycle leadership experience of 2 or more years.
  • Other:

Preferred Job Qualifications
  • Preferred Licensure or other certifications:
  • Preferred Educational Requirements: Master's Degree in Nursing or other health related field preferred
  • Preferred Experience:
  • Other:

Job Specific and Unique Knowledge, Skills and Abilities
  • Proven ability to lead teams, manage budgets, and implement strategic initiatives.
  • Strong ability to educate and influence physicians, staff, and leadership on UM best practices.
  • Experience in data analysis, KPI tracking, and performance improvement strategies.
  • Expertise in medical necessity criteria, payer regulations, and revenue cycle principles.
Essential Tasks and Responsibilities
  • Oversee day-to-day operations of the Utilization Management Department, ensuring compliance with payer requirements and regulatory standards.
  • Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance.
  • Monitor and analyze key performance indicators (KPIs), financial goals, and length of stay (LOS) metrics to drive performance improvements.
  • Recruit, train, and manage a high-performing UM team, ensuring operational alignment with hospital objectives.
  • Manage departmental budgets, ensuring financial responsibility and resource allocation
  • Develop and implement performance metrics to evaluate team effectiveness and drive continuous improvement.
  • Foster strong relationships with internal and external stakeholders, including hospital executives, physicians, and payers.
  • Provide data-driven insights and strategic recommendations to hospital leadership regarding UM performance.
  • Act as the operational leader for process improvement initiatives related to utilization management, and revenue cycle optimization.
  • Work closely with Physician Advisors to develop and revise policies and procedures related to clinical status determination, medical necessity, denials and appeals, and physician education.
  • Review daily, weekly and monthly reports to monitor and analyze performance of UM departments, assess data against KPI standards and goals, and identifies trends to make adjustments as indicated. Keeps leadership, staff, and clinical staff (where appropriate) informed.
  • Oversees UM working closely with Case Management and other members of the interdisciplinary team to ensure effective collaboration for length of stay and throughput.
  • Communicate with and educate physicians and other key stake holders regarding Utilization Review policies, practices, and procedures to ensure safe, effective services, along with appropriate transitions of care.
  • Assesses departmental workload to determine appropriate staff allocations to ensure productivity standards are being met consistently.
  • Works closely with physicians and staff to provide and monitor clinical/financial data for the purpose of improving hospital/physician performance and anticipating payer and managed care demands.
  • Actively participates as the operational leader for UM in committees including but not limited to MRUR; Compliance; Policy and Procedures; and Quality
  • Identifies and maintains good relationships with other departments such as Managed Care, Patient Financial Services, Patient Access, and others so to facilitate the utilization review processes and to provide continuity of care.
Physical Demands
  • Weight Lifted: Up to 20 lbs, Frequently 31-65% of time
  • Weight Carried: Up to 20 lbs, Frequently 31-65% of time
  • Vision: Moderate, Frequently 31-65% of time
  • Kneeling/Stooping/Bending: Occasionally 0-30%
  • Standing/Walking: Constantly 66-100%
  • Pushing/Pulling: Constantly 66-100%
  • Intensity of Work: Occasionally 0-30%
  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

What Northeast Georgia Health System employees say

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About Northeast Georgia Health System

Sourced by ZipRecruiter

Northeast Georgia Health System (NGHS) is a not-for-profit community health system dedicated to improving the health and quality of life of the people of Northeast Georgia. Through the services of a medical staff of more than 800 physicians, the residents of Northeast Georgia enjoy access to the state’s finest and most comprehensive medical services. It is our mission to improve the health of our community in all we do.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Gainesville, GA, US

Year founded

1951

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