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Remote Utilization Review Jobs in Powder Springs, GA

FormativGroup

Cloud Solution Architect

Atlanta, GA · Remote

$61 - $83.75/hr

Support hands-on delivery as needed, including Salesforce configuration, data loads, and review of ... Proven leadership of Salesforce delivery teams, including onshore/offshore models, remote teams ...

Fluxx

Senior Director, Professional Services

Atlanta, GA · Remote

$10K/mo

This is a full-time exempt and remote position. Candidates must be located in the United States ... Drive improvements in throughput, resource utilization, and burn rate while maintaining high ...

New

Koenig & Bauer US, Inc

Service Manager

Decatur, GA · Remote

$100K - $125K/yr

This role is responsible for overseeing field service operations, technician utilization, work ... Review and approve custom labor quotes, balancing profitability with strategic customer ...

EVERSANA

Regional Diagnostic Director

Atlanta, GA · On-site +1

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

EVERSANA

Regional Diagnostic Director

Atlanta, GA · Remote

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

Eversana

Regional Diagnostic Director

Atlanta, GA · Remote

This is a remote field-based position. Candidates should live in close proximity to a large airport ... Educate HCPs and associated internal partner labs for seamless sponsored testing utilization

Tihinsurance

Senior Treasury Analyst

Atlanta, GA · Remote

English (Required) Work Shift: 1st Shift (United States of America) Please review the following ... This role is remote, but we would prefer someone in Charlotte, Dallas, Birmingham, New York ...

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Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for remote utilization review in Powder Springs, GA is $40.04, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $45.96 per hour, depending on experience, location, and employer.

What is a remote utilization review?

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 does a remote utilization review do?

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 are the key skills and qualifications needed to thrive in remote utilization review?

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.

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Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Powder Springs, GA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $83,279 per year, or $40 per hour.

PBM Sr. Strategic Account Executive Remote

UnitedHealth Group

Atlanta, GA • On-site, Remote

Full-time

Retirement

This job post has expired today. Applications are no longer accepted.

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

192nd of 898 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Sr. Strategic Account Executive is an individual contributor role serving as the senior - level liaison to assigned client accounts. Responsible for developing client trend management strategies, retaining, and growing assigned clients, cultivating multi-level client relationships, and managing staff.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Managing assigned accounts with a focus on client trend management, strategic plan development and execution, cultivating multi-level client relationships and management staff
  • Managing client contract renewal activities with the primary goals of retaining client, obtaining multiple-year agreements and maintaining or improving profitability
  • Maintaining consistent and regular client communications. Preparing and presenting regular client performance reviews, including identification of cost drivers, recommendations for cost savings opportunities, utilization and cost reports
  • Prioritizes and conducts regular on - site or telephonic client meetings as appropriate to proactively review client benefits, drug utilization and trend management strategies
  • Ensure that all client specific requirements are met including but not limited to (1) maintaining documentation of most current benefit designs, including exclusions, inclusions, formularies and co - pay structures and that information is accessible to Customer Service Pharmacy Technicians; (2) documenting plan change requests from clients and obtains appropriate approval, updates the Benefit Design Summary on the web, and confirms the plan change is completed and accurate; (3) following all audit requirements.
  • Reviews Benefit Design Summary documents at least annually with clients and receives appropriate client signature approval
  • Maintaining a complete understanding of client contract terms including but not limited to the monitoring and reporting of performance guarantees. Ensuring that all assigned contracts are monitored and reported as stated in the terms
  • Developing strategies for staff development and retention
  • Cultivating in - group growth through these relationships
  • Staying abreast of industry trends and developments and demonstrating solid communication skills in presenting these to clients and staff
  • Demonstrating expertise in pharmacy benefit strategies and clinical programs
  • Supervising and assisting in the development of client specific implementation plans and managing overall client implementations
  • Providing leadership to client services team members in departmental and corporate initiatives
  • Providing regular feedback to management team regarding client requirements and business development opportunities
  • Participating in sales preparation meetings and finalist sales presentations as necessary
  • Ensuring quick response and follow - up to client inquiries, including returning phone calls and emails within 2 hours and attempted resolution of all issues in less than 48 hours
  • Follows - up with client within 24 hours after issue resolution
  • Regularly attending and actively participating in company meetings as requested
  • Participating as preceptor / mentor to new staff as requested. Assisting in the development of ongoing training topics and materials for staff
  • Following all policies and procedures relating to job responsibilities and participates in the development and maintenance of departmental policies and procedures for Client Services, as appropriate
  • Performing other duties as assigned to meet corporate objectives
  • Providing support to other departments as requested

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • 4+ years of strategic PBM client account and contract management
  • 2+ years of experience in the Health Plan Commercial Market
  • Understanding of pharmacy benefit strategies and pricing practices
  • Advanced proficiency in delivering presentations to various audiences
  • Proficient with MS suite - Word, Excel, PowerPoint
  • Proven ability to handle complex client issues
  • Proven solid PBM business and financial acumen
  • Demonstrates a high degree of client focus and attention to service
  • Proven excellent negotiation skills
  • Ability to travel up to 25% of the time

Preferred Qualifications:
  • 1+ years PBM Medicaid client management experience
  • Project Management Experience/Certification
  • 3+ years of experience with upsell programs to clients
  • 2+ years of PBM operations experience
  • Familiarity with RxClaim; Tracker and Navigator

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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