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Remote Utilization Management Jobs in Georgia (NOW HIRING)

Aprio

Senior Director, Resource Management

Atlanta, GA · On-site +1

$225K - $300K/yr

Analyze trends in utilization, availability, backlog, pipeline, and seasonal demand to drive timely ... remote and hybrid options What's in it for you: - Working with an industry leader : Be part of a ...

Aprio

Senior Director, Resource Management

Alpharetta, GA · On-site +1

$225K - $300K/yr

Analyze trends in utilization, availability, backlog, pipeline, and seasonal demand to drive timely ... remote and hybrid options What's in it for you: - Working with an industry leader : Be part of a ...

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

Oscar Health

Manager, Optimization

Atlanta, GA · Remote

$105K - $138K/yr

... utilization. You will report into the Associate Director, MPSO - Optimization. Work Location ... This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully ...

Origami Risk LLC

Manager, Account Management

Atlanta, GA · On-site +1

Partner with service leaders to ensure customer success delivery and service hour utilization and ... All full-time positions are hybrid, with many eligible to be completely remote * Fully Paid by ...

Origami Risk LLC

Manager, Account Management

Atlanta, GA · On-site +1

Partner with service leaders to ensure customer success delivery and service hour utilization and ... All full-time positions are hybrid, with many eligible to be completely remote * Fully Paid by ...

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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 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.
Clinical Manager - Remote

Clinical Manager - Remote

United Energy Workers Healthcare

Atlanta, GA • On-site, Remote

$80K - $90K/yr

Full-time

Posted 5 days ago

Job description

Overview
We are a compassionate company driven by a personal commitment to exceptional care. Founded by the grandchildren of a former Department of Energy worker, we elevate the lives of energy workers with unwavering compassion and whole-person care.
Our mission is guided by our founders' deep commitment to high-quality care under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA). With over 14 years of experience and operations across 24 states, we strive to make a meaningful difference in the lives of energy workers and their families.
The Clinical Manager oversees the clinical aspects of patient care, ensuring compliance with regulations and leading a team of healthcare professionals. Strong leadership, organizational skills, and expertise in home health care are essential.
Responsibilities
  • Axxess Management: Ensure accurate documentation and compliance with QA reviews.
  • Case Management: Lead patient recertification, hospitalization, and discharge processes.
  • Patient Care & DME: Oversee disease progression, manage DME, and conduct retention visits.
  • Staff Oversight: Supervise Case Managers, RN/LPN contractors, and intake nurses. Assist with hiring, onboarding, and evaluations.
  • Caseload & Utilization: Manage caseload distribution, ensure productivity, and monitor patient census.
  • Compliance: Maintain QA compliance, lead QAPI meetings, and ensure readiness for surveys.
  • Regulatory Adherence: Ensure HIPAA compliance and adherence to all relevant regulations and standards.
  • Professional Development: Stay current with advancements in home health care practices and technologies.

Qualifications
  • Current RN license and CPR certification.
  • Experience in home health care or healthcare management.
  • Knowledge of regulations, accreditation standards, and EMR systems.
  • Strong assessment, communication, and interpersonal skills.
  • Proficiency in Microsoft Office Suite and analytical problem-solving.
  • Flexibility for occasional night and weekend hours.
  • Must pass a criminal background check and drug screen.

Pay Range
USD $80,000.00 - USD $90,000.00 /Yr.

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