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Remote Utilization Review Jobs in Decatur, GA (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Lawrenceville, GA · On-site +1

$49.50 - $60.25/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Atlanta, GA · On-site +1

$55 - $67/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

OncoHealth

Case Review Specialist - Atlanta

Atlanta, GA · On-site +1

Experience working remote independently * A minimum of 2-4 years' administrative experience and/or ... Our Current Solutions Through the use of OncoHealth's utilization management system, OneUM , our ...

Aldridge Pite

Title Reviewer

Atlanta, GA · Remote

Remote Work from Home! Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the ... Purpose Review title reports on properties referred for foreclosure and identify any defects that ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

... reviews utilization of mental health and substance abuse services provided in inpatient and ... The Alpharetta, GA candidate will also have the ability to work remote. This is an inbound ...

US Tech Solutions

Licensed Vocational Nurse

Atlanta, GA · Remote

$25 - $27/hr

$25-$27 per hour remote, GA Contract This is a remote position and requires the ability to ... Review criteria-based prior authorizations following policy and procedure. * Provide on-call after ...

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All JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Decatur, GA

Remote Utilization Review information

See Decatur, GA salary details

$20

$41

$67

How much do remote utilization review jobs pay per hour?

As of Jun 20, 2026, the average hourly pay for remote utilization review in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?

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.

What does a typical day look like for someone in a Remote Utilization Review role?

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.

What is a Remote Utilization Review job?

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.

What are the most commonly searched types of Utilization Review jobs in Decatur, GA? The most popular types of Utilization Review jobs in Decatur, GA are:
What are popular job titles related to Remote Utilization Review jobs in Decatur, GA? For Remote Utilization Review jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Decatur, GA look for? The top searched job categories for Remote Utilization Review jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Remote Utilization Review jobs? Cities near Decatur, GA with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Decatur, GA as of June 2026, with employment types broken down into 80% Full Time, 7% Part Time, and 13% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.

Appeals Pharmacist (Remote)

Pharmacy Careers

Lawrenceville, GA • On-site, Remote

$49.50 - $60.25/hr

Other

Posted 28 days ago

Job description

Appeals Pharmacist - Ensure Fair Medication Access for Patients
A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.
Key Responsibilities

  • Review clinical documentation for medication coverage appeals and grievances.
  • Apply evidence-based guidelines, plan policies, and regulatory requirements to determine outcomes.
  • Prepare written clinical rationales to support appeal determinations.
  • Collaborate with physicians, nurses, and medical directors during case reviews.
  • Track, document, and report appeal outcomes in compliance with state and federal regulations.
  • Support process improvements to enhance timeliness and quality of appeal decisions.


What You'll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply.
  • Skills: Excellent clinical judgment, written communication, and attention to regulatory detail.


Why This Role?

  • Impact: Play a critical role in ensuring patients get fair access to necessary medications.
  • Growth: Gain expertise in appeals, utilization management, and managed care pharmacy.
  • Flexibility: Many roles offer hybrid or fully remote options.
  • Rewards: Competitive salary, comprehensive benefits, and opportunities for advancement.


About Us
We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.
Apply Today
Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.

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