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 ...
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 ...
Lawrenceville, GA · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
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Lawrenceville, GA · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Lawrenceville, GA · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Lawrenceville, GA · Remote
$63K - $95K/yr
Strong cost containment background, such as utilization review or managed care helpful ... Remote
Lawrenceville, GA · On-site +1
Remote or any Colony Bank location with available space Position Overview: The Director of Digital ... Negotiate contracts, manage Service Level Agreements (SLAs), and conduct quarterly business reviews.
Lawrenceville, GA · On-site +1
Remote or any Colony Bank location with available space Position Overview: The Director of Digital ... Negotiate contracts, manage Service Level Agreements (SLAs), and conduct quarterly business reviews.
... capacity utilization. * Develop technical solutions involving AC and DC power systems, UPS ... Support RFP responses, technical evaluations, and customer design reviews. * Deliver customer ...
... capacity utilization. * Develop technical solutions involving AC and DC power systems, UPS ... Support RFP responses, technical evaluations, and customer design reviews. * Deliver customer ...
Alpharetta, GA · On-site +1
... of employee utilization and value. RESPONSIBILITIES * Leads a team of benefits professionals ... Leads vendor selection activities (including RFPs), contract negotiations and reviews, and ...
New
Alpharetta, GA · On-site +1
... of employee utilization and value. RESPONSIBILITIES * Leads a team of benefits professionals ... Leads vendor selection activities (including RFPs), contract negotiations and reviews, and ...
New
Duluth, GA · On-site +1
$107K/yr
Remote or Hybrid (Duluth, GA) Requirements What You'll Be Responsible For Project Management ... Monitor project health, capacity, utilization, and portfolio metrics. * Analyze project trends and ...
Duluth, GA · On-site +1
$107K/yr
Remote or Hybrid (Duluth, GA) Requirements What You'll Be Responsible For Project Management ... Monitor project health, capacity, utilization, and portfolio metrics. * Analyze project trends and ...
Flowery Branch, GA · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
Flowery Branch, GA · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
GA · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
GA · Remote
$17.75 - $23.25/hr
While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred
$19.95 - $23.98
2% of jobs
$23.98 - $28.02
9% of jobs
$30.78 is the 25th percentile. Wages below this are outliers.
$28.02 - $32.05
21% of jobs
The median wage is $35.32 / hr.
$32.05 - $36.09
23% of jobs
$36.09 - $40.12
13% of jobs
$43.26 is the 75th percentile. Wages above this are outliers.
$40.12 - $44.16
10% of jobs
$44.16 - $48.19
8% of jobs
$48.19 - $52.23
5% of jobs
$52.23 - $56.26
5% of jobs
$56.26 - $60.30
2% of jobs
$60.30 - $64.33
2% of jobs
$19
$39
$64
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 Gainesville, GA are:
For Remote Utilization Review jobs in Gainesville, GA, the most frequently searched job titles are:
The top searched job categories for Remote Utilization Review jobs in Gainesville, GA are:
Cities near Gainesville, GA with the most Remote Utilization Review job openings:
$19.50 - $25.25/hr
Full-time
Re-posted 15 days ago
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Education Level: Master's
This is a TEMP-TO-PERM Care Manager RN position. The position is created to meet and exceed the service level requirements to their customers.
These positions require a Master's Degree and a LCSW or LCPC license.
Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience. She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.
Description:
Under general supervision, and in collaboration with other members of the clinical team, reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects. Monitors level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation.- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.- Participates in quality improvement activities, including data collection, tracking, and analysis Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Requirements/Certifications:
Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
Knowledge and experience in inpatient setting.
Knowledge of DSM V or most current diagnostic edition. Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience.
She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.
The manager will give preference to candidates located in the Alpharetta, GA area; however, she is open to remote candidates as well.
The Alpharetta, GA candidate will also have the ability to work remote.
This is an inbound telephonic position and the selected candidate will manager about 25 calls/day.
The majority of the calls are from providers and the other calls are from members and their family members.
The selected candidate will have 1-2 years of Managed Care/Clinical Review experience and 3-5 clinical experience.
There are 55 people on this team and it is divided into 3 clusters.
The training will be web based and it will be about 2-3 weeks long. The hours will be from 8am - 5pm.
The selected candidate MUST be comfortable with navigating through multiple systems and comfortable with Outlook, Instant Messenger and Email. The manager will conduct telephone intervie
LCSW or LCPC license
Riya Khem
Life Science Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
Sourced by ZipRecruiter
Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.
Recruiting and staffing services
51 - 200 Employees
Edison, NJ, US
1996
