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Remote Utilization Management Jobs in Duluth, GA

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 ...

Oscar Health

Director, Medical Economics

Atlanta, GA · Remote

$178K - $234K/yr

You will manage your team to contribute analyses, reports, and dashboards to the medical economics ... This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote ...

Koenig & Bauer US, Inc

Service Manager

Decatur, GA · Remote

$100K - $125K/yr

Department Operations & Resource Management * Work Order Execution: Oversee the end-to-end service ... Analyze technician utilization and scheduling to meet market demand; build training and development ...

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 ...

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Duluth, GA

Remote Utilization Management information

See Duluth, GA salary details

$19

$38

$63

How much do remote utilization management jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for remote utilization management in Duluth, GA is $38.92, according to ZipRecruiter salary data. Most workers in this role earn between $30.77 and $44.71 per hour, depending on experience, location, and employer.

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 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 popular job titles related to Remote Utilization Management jobs in Duluth, GA?

For Remote Utilization Management jobs in Duluth, GA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Duluth, GA look for?

The top searched job categories for Remote Utilization Management jobs in Duluth, GA are:

What cities near Duluth, GA are hiring for Remote Utilization Management jobs?

Cities near Duluth, GA with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Duluth, GA as of August 2026, with employment types broken down into 90% Full Time, 3% Part Time, and 7% Contract. Highlights an 7% In-person, 2% Hybrid, and 91% Remote job distribution, with an average salary of $80,948 per year, or $38.9 per hour.

Senior Healthcare Data Analyst

Imagine Staffing Technology

Atlanta, GA • Remote

$150K - $160K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 14 hours ago

Job description

Job Title: Senior Medical Economics Analyst
Location: Remote (Atlanta, GA preferred)
Hire Type: Direct Hire
Pay Range: $150,000 - $160,000 Base Salary + 10% Bonus + Equity Participation
Work Model: Remote Preferred | Atlanta-Based Candidates Preferred
Schedule: Monday – Friday, Standard Business Hours
Recruiter Contact: Samantha Marranca | 716-256-1271 | smarranca@imaginestaffing.net
Nature & Scope:
Positional Overview
Our client is seeking a highly analytical and business-minded Senior Medical Economics Analyst to support the continued evolution of its healthcare analytics and predictive insights capabilities.
This is a newly created position reporting into senior leadership and will play a critical role in helping the organization transition from retrospective healthcare reporting toward forward-looking predictive analytics and strategic healthcare insights. The successful candidate will leverage healthcare economics expertise, advanced analytics, statistical methodologies, and consultative problem-solving to support executive leadership, client-facing teams, provider organizations, and value-based healthcare initiatives.
The ideal candidate will possess deep experience working with healthcare claims and population health data, demonstrate strong predictive modeling capabilities, and have the ability to transform complex healthcare data into actionable business recommendations.
This role offers the opportunity to directly influence organizational strategy, support executive decision-making, and contribute to innovative healthcare solutions focused on improving patient outcomes while reducing healthcare costs.
Role & Responsibility:
Tasks That Will Lead To Your Success
  • Analyze large-scale healthcare datasets to identify trends, risks, opportunities, and performance drivers
  • Evaluate provider performance, utilization patterns, referral behaviors, quality outcomes, and healthcare costs
  • Conduct healthcare economics analyses including:
    • PMPM (Per Member Per Month) analysis
    • Utilization trend analysis
    • Cost decomposition analysis
    • Medical cost economics evaluations
    • Quality and performance measurement
  • Perform risk-adjusted financial and utilization analyses across Commercial, Medicare Advantage, and Medicaid populations
  • Analyze longitudinal healthcare performance across multiple reporting periods
Predictive Analytics & Statistical Modeling
  • Design, develop, and operationalize predictive analytics solutions
  • Build and maintain statistical models to identify future healthcare risks and opportunities
  • Develop probability-based models supporting:
    • Population health initiatives
    • Patient risk stratification
    • Utilization forecasting
    • Cost prediction
    • Quality outcome measurement
  • Apply methodologies such as:
    • Logistic regression
    • Risk adjustment
    • Difference-in-differences analysis
    • Credibility weighting
    • Benchmarking methodologies
    • Performance normalization techniques
  • Support the organization's transition toward proactive, forward-looking healthcare insights
Data Management & Technical Analysis
  • Write advanced SQL queries to extract, transform, and analyze healthcare data
  • Create episode-level, provider-level, and member-level datasets
  • Leverage healthcare claims, enrollment, provider, and risk-adjustment data sources
  • Utilize SQL, Tableau, Excel, and Python to develop analytical solutions
  • Normalize healthcare data to account for demographic, reimbursement, geographic, and population changes
  • Ensure analytical methodologies produce accurate, meaningful, and actionable results
Strategic Consulting & Business Partnership
  • Partner with executive leadership, client success teams, sales leadership, providers, and customers to address complex business questions
  • Translate analytical findings into clear business recommendations
  • Serve as a consultative resource by identifying additional insights beyond the original request
  • Present findings to technical and non-technical audiences
  • Help stakeholders understand both the "what" and the "why" behind healthcare performance trends
  • Recommend strategic actions based on analytical findings
Value-Based Care & Program Evaluation
  • Support evaluation and optimization of value-based care programs
  • Analyze episode-of-care performance and specialty care utilization
  • Assist with pricing validation and reconciliation methodologies
  • Support network optimization and care management initiatives
  • Evaluate financial and quality outcomes across multiple healthcare populations
  • Develop frameworks supporting value-based pricing and performance measurement
Skills & Experience
Qualifications That Will Help You Thrive
Required Experience
  • Bachelor’s Degree in Healthcare Analytics, Statistics, Mathematics, Economics, Actuarial Science, Data Science, Computer Science, Public Health, or related STEM discipline
  • 5+ years of healthcare analytics, medical economics, population health, healthcare consulting, payer, or health plan experience
  • Advanced SQL expertise with demonstrated experience analyzing large healthcare datasets
  • Strong healthcare economics background including medical cost analysis, utilization analysis, and performance measurement
  • Experience working with:
    • Medical Claims Data
    • Enrollment & Eligibility Data
    • Provider Data
    • Healthcare Performance Data
    • Value-Based Care Programs
  • Experience developing predictive analytics and statistical models
  • Strong analytical storytelling and consultative communication skills
  • Ability to independently manage complex projects and shifting priorities
Preferred Experience
  • Master's Degree in a quantitative discipline
  • Actuarial credentials (ASA, FSA) or actuarial experience
  • Biostatistics experience within healthcare environments
  • Experience supporting payer or health plan organizations
  • Population health analytics experience
  • Value-based care and episode-of-care experience
  • Advanced predictive modeling expertise
  • Python or R programming experience
  • Tableau development experience
  • Experience presenting findings to executive leadership and external stakeholders
Team & Environment
  • Reports directly to senior healthcare analytics leadership
  • Small, highly collaborative analytics team
  • Significant visibility with executive leadership
  • Opportunity to influence organizational strategy
  • Fast-paced environment with changing priorities
  • High level of autonomy and ownership
  • Exposure to leadership teams, provider organizations, customers, sales leadership, and client success stakeholders
Compensation & Benefits
Compensation
  • Base Salary: $150,000 – $160,000
  • Annual Bonus Opportunity (~10%)
  • Stock Option / Equity Participation
Benefits
  • Company-paid Medical, Dental, and Vision Coverage (select plans)
  • Annual HSA Contribution (~$1,740)
  • 401(k) with Company Match
  • Unlimited PTO
  • Company-Paid Life Insurance
  • Company-Paid Short-Term & Long-Term Disability
  • Employee Assistance Program
  • Professional Development Support
Why Join This Opportunity?
This is an opportunity to help shape the future of healthcare analytics within a growing organization focused on healthcare economics, predictive insights, and value-based care initiatives. You'll have direct exposure to executive leadership, meaningful ownership over strategic initiatives, and the ability to drive measurable impact across healthcare cost, quality, and patient outcomes.
Unlike larger organizations where analytics teams are highly specialized, this role offers broad influence, visibility, and the opportunity to build innovative solutions that directly affect business strategy and client success.