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Utilization Management Auditor Jobs in Georgia (NOW HIRING)

... and utilization of business applications, enabling clients to achieve their strategic objectives ... risk management and corrective actions - Leading compliance auditing and audit documentation ...

... management and supervision of assigned power blocks. VoltaGrid designs, owns, and operates gas ... Ensure the efficient utilization of space and resources within the facility. * Collaborates and is ...

Accountant

Alpharetta, GA · On-site

$53K - $70K/yr

... management reports. * Support accounts payable, accounts receivable, and fixed asset accounting ... Compile and organize documentation requested by external auditors and tax advisors. * Help ensure ...

Optimize ERP system utilization and financial reporting capabilities * Support system ... Ability to manage multiple priorities in a fast-paced environment Please send your resume to [email ...

Job Summary The Benefits Specialist will manage employee leave programs and supports benefits ... Compliance and Invoice Auditing: Conduct periodic audits of leave administration, benefit ...

Showing results 41-60

Utilization Management Auditor information

What is a utilization management auditor?

A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.

What are the key skills and qualifications needed to thrive as a utilization management auditor?

To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.

What are some common challenges faced by utilization management auditors and how can they be addressed?

Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.

What is the difference between Utilization Management Auditor vs Utilization Review Nurse?

AspectUtilization Management AuditorUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or CUCLicensed Registered Nurse (RN), often with additional certifications
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinics, insurance companies, often in clinical settings
Primary FocusAuditing and reviewing utilization data for compliance and cost managementAssessing patient care needs and determining appropriate services

While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.

What are popular job titles related to Utilization Management Auditor jobs in Georgia?

For Utilization Management Auditor jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Utilization Management Auditor jobs in Georgia look for?

The top searched job categories for Utilization Management Auditor jobs in Georgia are:

Infographic showing various Utilization Management Auditor job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution.

SAP Business Process & IT Controls Manager

Pwc

Atlanta, GA • On-site

$99K - $232K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 5 days ago


PwC rating

8.3

Company rating: 8.3 out of 10

Based on 76 frontline employees who took The Breakroom Quiz

26th of 72 rated business consultants


Job description

Industry/Sector

Not Applicable

Specialism

SAP

Management Level

Manager

Job Description & Summary

The Opportunity
As a SAP Business Process & IT Controls Manager, you will specialize in consulting services for a variety of business applications, helping clients optimize operational efficiency. You will analyze client needs, implement software solutions, and provide training and support for seamless integration and utilization of business applications, enabling clients to achieve their strategic objectives. As a Manager, you will lead teams and manage client accounts, focusing on strategic planning and mentoring junior staff. You are accountable for confirming project success and maintaining standards. Enhancing your leadership style, you motivate, develop, and inspire others to deliver quality. You are responsible for coaching, leveraging team members' unique strengths, and managing performance to deliver on client expectations. With your growing knowledge of how business works, you play an important role in identifying opportunities that contribute to the success of our Firm. You are expected to lead with integrity and authenticity, articulating our purpose and values in a meaningful way. You embrace technology and innovation to enhance your delivery and encourage others to do the same.
In this role within our Technology Consulting practice, you will focus on providing consulting services for confirming compliance and enhancing security within SAP applications. You will analyze client requirements, implement security measures, and offer guidance and support for compliance with regulatory standards. Working in this area, you will enable clients to mitigate risks, protect sensitive data, and maintain compliance with industry regulations.
Responsibilities
- Leading SAP compliance and security consulting services to confirm compliance and enhance security within SAP applications
- Analyzing client requirements and implementing security measures to protect sensitive data and maintain compliance with industry regulations
- Guiding teams in strategic planning and execution of SAP compliance initiatives
- Developing and overseeing the deployment of compliance technology solutions to mitigate risks
- Coaching team members to leverage their unique strengths and manage performance to meet client expectations
- Utilizing SAP Governance, Risk and Compliance (GRC) tools to enhance operational efficiency and compliance oversight
- Building and maintaining relationships with clients to identify and address compliance challenges
- Promoting the use of innovative technologies and leading practices across SAP compliance teams
- Addressing conflicts or issues, engaging in difficult conversations with clients and stakeholders, escalating where appropriate
- Upholding professional and technical standards, including PwC's code of conduct and independence requirements
What You Must Have
- At least a Bachelor's degree
- At least 4 years of experience of experience delivering SAP compliance, security, and governance solutions, including auditing, advisory, and implementation engagements
What Sets You Apart
- Demonstrating proficiency in SAP Governance, Risk and Compliance (GRC)
- Utilizing SAP BW/4HANA for advanced data analytics
- Implementing compliance programs and governance frameworks
- Developing policies and guidelines for regulatory compliance
- Excelling in operational risk management and corrective actions
- Leading compliance auditing and audit documentation processes
- Embracing change and fostering innovation in compliance technology

Travel Requirements

Up to 40%

Job Posting End Date

The salary range for this position is: $99,000 - $232,000. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. All hired individuals are eligible for an annual discretionary bonus. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link: https://pwc.to/benefits-at-a-glanceAs PwC is anequal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law.PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.Learn more about how we work: https://pwc.to/how-we-workFor only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.

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Pay

Benefits

Hours and flexibility

Workplace

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About pwc

Sourced by ZipRecruiter

We know that the future success of our firm is contingent on equitable experiences for our people. From recruitment to partnership, we’re working hard to give every person an equitable opportunity to grow and to thrive as part of our community of solvers. We understand that establishing and maintaining a fair, equitable and welcoming environment for all people requires building a culture of belonging: a shift from awareness to empathy — while demonstrating inclusive leadership that cultivates trust among our people and our clients. PwC is committed to advancing diversity, equity and inclusion (DEI) through an evidence-based strategy designed to achieve well-defined and meaningful aspirational goals. Our aim is to solve problems for the long term, as that is how we build trust and continue to build on our culture of belonging. At the core of this endeavor are stated goals and a series of linked programs enabling targeted interventions at key moments in our employees’ career trajectories.

Industry

Finance and insurance

Company size

10,000+ Employees

Headquarters location

London, London, UK