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Remote Utilization Management Jobs in Georgia (NOW HIRING)

... 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 ...

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Remote Utilization Management information

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 servicesβ€”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 are the key skills and qualifications needed to thrive in remote utilization management?

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.

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 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 cities in Georgia are hiring for Remote Utilization Management jobs?

Cities in Georgia with the most Remote Utilization Management job openings:

Infographic showing various Remote Utilization Management job openings in Georgia as of September 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution.

Licensed Clinical Social Worker (LCSW) - Remote - Hospice Care Specialist

Atlanta, GA β€’ Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 11 days ago


Job description

Position Overview

Adelante Life Solutions, Inc. is seeking a compassionate and skilled Licensed Clinical Social Worker (LCSW) to join our dedicated team. This full-time remote position is centered on providing exceptional mental health support within a hospice center setting, focusing on the well-being and dignity of patients and their families. You will play an integral role in creating individualized care plans and fostering a supportive environment for clients navigating end-of-life experiences.

About the Organization

At Adelante Life Solutions, Inc., we are committed to delivering exceptional mental health services tailored to a diverse spectrum of needs. Our organization prides itself on cultivating a safe and nurturing environment where our multidisciplinary team of professionals works collaboratively to empower clients on their journey towards healing and personal growth. We value the unique backgrounds and experiences of our team members, fostering an atmosphere of inclusivity and respect.

Work Environment

This remote role allows for flexibility, with a full-time schedule of Monday to Friday from 9:00 AM to 5:00 PM. You will be supported by a dynamic virtual team, all committed to shared goals of providing holistic care. Our commitment to remote work enables you to deliver care effectively while maintaining a work-life balance.

Key Responsibilities
  • Act as a liaison between clients, their families, and outpatient providers to ensure coordinated care and support.
  • Interact with insurance companies for pre-certification and utilization management, advocating for clients' needs.
  • Engage in discharge and aftercare planning, ensuring continuity of care and smooth transitions for patients.
  • Provide therapeutic meal support, guiding clients in developing a healthy relationship with food through practical, empathetic interaction.
  • Deliver safe and affirming care to each client, customizing approaches based on their unique circumstances, needs, and identities.
Patient Population / Client Focus

The primary focus of this position is to serve older adults in a hospice care setting. You will engage with patients experiencing complex physical and emotional challenges associated with end-of-life care. This role allows for the integration of clinical social work skills within a palliative care context, ensuring that every client receives support that acknowledges their individual experiences and identities.

Qualifications
  • A Master’s degree in Social Work from an accredited institution.
  • A valid LCSW license in the state of Georgia is required.
  • Demonstrated experience working with older adults, particularly in hospice or palliative care.
  • Strong clinical and diagnostic skills, particularly in emotional and psychosocial assessment.
  • Effective communication and interpersonal skills to foster a supportive therapeutic relationship.
  • Ability to work independently, as well as collaboratively within a team to meet organizational goals.
Preferred Experience
  • Experience with grief counseling and crisis intervention within hospice care settings.
  • Familiarity with electronic health record systems (EHR) to document client interactions and treatment plans effectively.
  • Knowledge of community resources specific to elder care to support client referrals and aftercare planning.
Compensation and Benefits

The salary for this position ranges from USD 90,000 to 105,000 annually, reflecting your experience and expertise in the field. In addition to competitive pay rates, we offer a comprehensive benefits package including:

  • Medical, Dental, and Vision insurance to support your health and wellness.
  • 401(k) savings plan with a generous company match to help you secure your financial future.
  • Flexible Spending Accounts (FSA) for medical expenses.
  • Life insurance and accident coverage, along with short-term disability policies.
Career Growth Opportunities

At Adelante Life Solutions, Inc., we believe in nurturing the professional growth of our employees. This role offers opportunities for further training and certification in specialized areas of social work and palliative care. You'll also be encouraged to take part in regular team meetings, workshops, and mentoring sessions, contributing to your professional development and opening pathways to leadership roles within the organization.

Why Join Our Team

If you are passionate about making a meaningful difference in the lives of individuals and families facing end-of-life challenges, Adelante Life Solutions, Inc. is the ideal place for you. Our supportive and collaborative culture values every member's contributions and provides the resources needed to thrive. Join us in our mission to empower clients, respect their dignity, and promote healing, and enjoy the benefits of a meaningful and flexible career.

Application Information

If you are interested in shaping the future of hospice care and making a transformative impact, apply today by submitting your resume and a cover letter detailing your relevant experiences and passion for social work. We look forward to welcoming you to our dedicated team!