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Utilization Case Manager Jobs in Georgia (NOW HIRING)

Corvel

Medical Case Manager I

Augusta, GA · On-site

$63K - $95K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Corvel

Medical Case Manager I

Lawrenceville, GA

$63K - $95K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Corvel

Medical Case Manager I

Augusta, GA · On-site

$63K - $95K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Elevance Health

Nurse Case Manager Lead

Atlanta, GA · On-site

Assists with development of utilization/care management policies and procedures, chairs and ... Case manager certification required within 3 years of starting in this role. Preferred Skills ...

Corvel

Medical Case Manager I

Athens, GA

$63K - $95K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Georgia

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Georgia? For Utilization Case Manager jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Georgia look for? The top searched job categories for Utilization Case Manager jobs in Georgia are:
What cities in Georgia are hiring for Utilization Case Manager jobs? Cities in Georgia with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Georgia as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

CASE MANAGER RN, CASE MANAGEMENT

SGMC Health

Valdosta, GA • On-site

Full-time

Medical, Life, Retirement, PTO

Re-posted 8 days ago

Job description

Description
WHAT IT'S LIKE AT SGMC HEALTH
Purpose. No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.
Excellence. We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.
Team Spirit. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.
Award Winning Performance. We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.
WHY YOU WILL LOVE SGMC HEALTH
SGMC has great benefit options, depending on the role that you are going into- including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:
  • Low Healthcare Insurance Premiums
  • 401(k) with employer match
  • Paid Time Off (PTO)
  • Employee discounts
  • Company paid life insurance
  • Short-Term and Long-Term Disability
  • Cancer Insurance
  • Accident Insurance
  • Pet Insurance
  • Tuition Reimbursement
  • On-the-job training and skills development
  • Opportunities for growth and advancement
  • Employee Assistance Program

JOB LOCATION : Main Campus
DEPARTMENT: CASE MANAGEMENT
SCHEDULE: Full Time, 8 HR Day Shift, 8-1630
Assesses, plans, implements, coordinates, monitors and evaluates potential options and services to meet an individual's health needs through communication and utilization of available resources to promote quality and cost effective outcomes.
Knowledge, skills and abilities:
  • RN or other applicable clinical licensure required. Bachelor's degree and/or certification in Case Management strongly preferred. Previous experience desired.
  • Recent sound clinical experience of 3-5 years. Must have extensive experience in a particular patient population or moderate experience in a broad population.
  • Documented competency in assigned patient population including age specific competency.
  • Demonstrated expertise in management, problem solving, critical thinking, and data management.
  • Knowledge of medical literature, research methodology, health care delivery systems, financial/reimbursement issues, utilization management, and the medical center/medical staff organizations.
  • Computer skills desirable (must be willing to learn spreadsheet analysis, statistical functions, word processing). Ability to understand larger scope of hospital-wide information systems.
  • Excellent written and verbal communication skills. Ability to influence decisions, gain cooperation, and
  • facilitate change with physicians, all levels of management, employees and supervisors of other hospital Departments.

Working Conditions:
Requires considerable sitting, standing, mental effort, stooping, bending, lifting and pushing. Requires operation of office equipment. Works in a high stress environment.
SEE WHAT ALL OF THE HYPE IS ABOUT
https://www.youtube.com/watch?v=_DeqKw8xk54

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