Medical
Dental
Vision
Retirement
PTO
Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...
Medical
Dental
Vision
Retirement
PTO
Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...
Medical
Dental
Vision
Retirement
PTO
Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...
Medical
Dental
Vision
Retirement
PTO
Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...
Medical
Dental
Vision
Retirement
PTO
Build and present performance reviews and executive-ready reporting; drive corrective action plans ... Recommend technology improvements (automation, templates, dashboards, portal utilization) to ...
$155K - $175K/yr
Medical
Dental
Vision
Retirement
PTO
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
$155K - $175K/yr
Medical
Dental
Vision
Retirement
PTO
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
... utilization, backlog, revenue forecasting, margin, and active project health (delivery status ... PS Team quarterly reviews, capacity planning cycles, resource allocation/project assignments, and ...
... utilization, backlog, revenue forecasting, margin, and active project health (delivery status ... PS Team quarterly reviews, capacity planning cycles, resource allocation/project assignments, and ...
Atlanta, GA · Remote
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · Remote
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · On-site +1
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · On-site +1
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · Remote
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · Remote
Retirement
... utilization management, or a related clinical specialty * Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows * Solid understanding of clinical ...
Atlanta, GA · Remote
$248K - $373K/yr
Retirement
Experience in utilization and clinical coverage review * Proven excellent oral, written, and interpersonal communication skills, facilitation skills * Proven data analysis and interpretation aptitude
Atlanta, GA · Remote
$248K - $373K/yr
Retirement
Experience in utilization and clinical coverage review * Proven excellent oral, written, and interpersonal communication skills, facilitation skills * Proven data analysis and interpretation aptitude
Decatur, GA · On-site +1
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Decatur, GA · On-site +1
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Decatur, GA · Remote
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Quick apply
Decatur, GA · Remote
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Decatur, GA · Remote
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Decatur, GA · Remote
$80K/yr
Fully Remote (Georgia Residents Only) Reports To: Executive Director Classification: 1099 ... Review staff productivity, service utilization, and caseload capacity on a regular basis to ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review and approve APP, RN, SW, and PharmD plans of care. * Provide direct and indirect patient ... This position will be remote within the designated market with occasional in-home patient treatment ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review and approve APP, RN, SW, and PharmD plans of care. * Provide direct and indirect patient ... This position will be remote within the designated market with occasional in-home patient treatment ...
Conyers, GA · On-site +1
$97K - $125K/yr
... Remote (Hybrid options available) About Raymond: We are a progressive, forward-thinking ... Monitor and manage departmental workload, utilization, staffing assignments, and resource planning.
Conyers, GA · On-site +1
$97K - $125K/yr
... Remote (Hybrid options available) About Raymond: We are a progressive, forward-thinking ... Monitor and manage departmental workload, utilization, staffing assignments, and resource planning.
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Quick apply
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Quick apply
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Atlanta, GA · Remote
Medical
Dental
Vision
Life
Retirement
PTO
Review, approve and co-sign APP encounters. * Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Review, approve and co-sign APP encounters. Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
Quick apply
Review, approve and co-sign APP encounters. Clinical and Operations Performance and Quality ... This position will be remote within the designated market with occasional in-home patient treatment ...
$18.06 - $21.72
2% of jobs
$21.72 - $25.37
9% of jobs
$27.87 is the 25th percentile. Wages below this are outliers.
$25.37 - $29.03
21% of jobs
The median wage is $31.98 / hr.
$29.03 - $32.68
23% of jobs
$32.68 - $36.33
13% of jobs
$39.17 is the 75th percentile. Wages above this are outliers.
$36.33 - $39.99
10% of jobs
$39.99 - $43.64
8% of jobs
$43.64 - $47.29
5% of jobs
$47.29 - $50.95
5% of jobs
$50.95 - $54.60
2% of jobs
$54.60 - $58.25
2% of jobs
$18
$35
$58
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
The most popular types of Utilization Review jobs in Georgia are:
For Remote Utilization Review jobs in Georgia, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in Georgia are:
Cities in Georgia with the most Remote Utilization Review job openings:

Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 26 days ago
8.5
Based on 10 frontline employees who took The Breakroom Quiz
79th of 245 rated software companies
MEDHOST, a division of Harris; is seeking an Account Follow-Up Services Team Leader who will provide strategic oversight of Hospital Insurance Follow-Up Services, including multi-team performance, payer strategy, denial prevention initiatives, workforce planning, and operational scaling.
This role drives measurable improvement in A/R aging, collections performance, and denial overturn rates through KPI leadership, cross-functional collaboration, training programs, continuous process innovation and adjust priorities on the fly.
This remote role welcomes candidates anywhere in the US. Preference will be given to candidates who can work in CST timezone.
Salary:
60K - 70K
AI & Innovation Mindset
We are committed to leveraging emerging technologies to improve how we work, serve our customers, and drive business outcomes. The successful candidate will demonstrate curiosity and a willingness to actively adopt and leverage AI tools to improve workflows, solve problems, and increase efficiency. Candidates should be comfortable using AI enabled technologies, including copilots, chat based AI assistants, and automation tools, as part of their everyday work while maintaining appropriate judgment, security, and compliance standards.
What your impact will be:
Operational & Performance Leadership
Denials Strategy & Payer Optimization
Training, Enablement & Quality Control
Innovation & Process Improvement
Cross-Functional & Client Partnership
What we are looking for:
What we can offer:
About MEDHOST:
MEDHOST, founded in 1984 and headquartered in Franklin, Tennessee, is a leading provider of healthcare information technology solutions. Serving over 1,000 healthcare facilities nationwide, MEDHOST offers a comprehensive suite of products, including electronic health records (EHR), financial management systems, and patient engagement platforms. Their mission is to empower healthcare organizations to enhance patient care and improve business operations through innovative, user-friendly solutions. In January 2024, MEDHOST was acquired by N. Harris Computer Corporation, further strengthening its position in the healthcare IT industry.
About Harris:
Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses.
#LI-remote
Get the full story on Breakroom
Sourced by ZipRecruiter
Harris Computer Systems, based in Ottawa, ON, CA, is an established player in the field of public sector software technology. Since its inception in 1976, the company has been striving to make clients' operations more efficient through reliable, practical, and flexible software solutions. Its extensive portfolio primarily serves utility, healthcare, public sector, and educational institutions, contributing to the betterment of public services through technology. Harris strongly believes in the value of forward-thinking technology and the power it has to drive progress for the public sector. This methodology is entirely in line with their mission to ensure customer success by providing reliable, practical, and robust software solutions.
Accounting services
1,001 - 5,000 Employees
Ottawa, ON, CA