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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

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.
RN - Utilization Management

RN - Utilization Management

Piedmont Healthcare Inc.

Atlanta, GA • On-site, Remote

Full-time

Posted 9 days ago

Piedmont Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 455 frontline employees who took The Breakroom Quiz

404th of 877 rated healthcare providers

Job description

Overview
Experience the advantages of real career change
Join Piedmont to move your career in the right direction. Stay for the diverse teams you'll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of work. You'll feel valued, motivated to be your best, and recognized for your contributions to exceptional patient outcomes. Piedmont leaders are in your corner, invested in your success. Our wellness programs and comprehensive total benefits and rewards meet your needs today and help you plan for the future.
Responsibilities
The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This roles monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures that the patient's payer has the clinical information with which to authorize an acute hospital stay and the continued stay services to include covered days and associated services.
Qualifications
Education
  • Graduate of an accredited nursing school Required
  • Bachelor's Degree of Science in Nursing Preferred
  • Master's degree Preferred
Work Experience
  • 2 years of experience in an acute, post-acute or payer setting Required
  • 3 years of utilization review or care management experience Preferred
Licenses and Certifications
  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required

Business Unit : Company Name
Piedmont Healthcare Corporate

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