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Utilization Management Non Clinical Jobs in Georgia

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Job Title Utilization Management Nurse Our mission is to enhance well-being by connecting ... • Assists non-clinical staff in performance of administrative reviews • Performing ...

Elevance Health

Utilization Management Rep I

Atlanta, GA · On-site

$16.86 - $21/hr

Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ... Non-Management Non-Exempt Workshift: Job Family: CUS > Care Support Please be advised that Elevance ...

Elevance Health

Utilization Management Rep I

Atlanta, GA · On-site

$15.96 - $18/hr

Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ... Non-Management Non-Exempt Workshift: Job Family: CUS > Care Support Please be advised that Elevance ...

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All JobsUtilization Management Non Clinical JobsUtilization Management Non Clinical Jobs in Georgia

Utilization Management Non Clinical information

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

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

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

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

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Cities in Georgia with the most Utilization Management Non Clinical job openings:

Utilization Management Non Clinical jobs near you
Infographic showing various Utilization Management Non Clinical job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, and 10% Remote job distribution.

Utilization Management Nurse

Dalton, GA • On-site

HealthONE
Health Care and Social Assistance • 10K+ employees
Learn more about HealthONEexternal

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Job description

Job Title

Utilization Management Nurse

Job Description

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

HealthOne is guided by a cultural framework that embodies our values and drives our decisions. Our purpose is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our priorities to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for people by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our process and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

Job Purpose

The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Essential Job Duties

• Initiate referrals to ensure appropriate coordination of care.
• Seek the advice of the Medical Director when appropriate, according to policy.
• Assists non-clinical staff in performance of administrative reviews
• Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.
• Regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned

Qualifications

• 3 years Clinical experience preferred
• 1-2 years of Utilization Review preferred
• Proficient in Microsoft Office (Outlook, Word, Excel)
• Working knowledge of NCQA preferred
• Must be able to work in an independent and creative manner.
• Ability to manage multiple projects and priorities
• Adaptive to high pace and changing environment
• Customer service oriented
• Proficient in interpreting benefits, contract language and medical policy/medical review criteria
• Current, active Compact State license in Nursing (RN).

Physical Requirements

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

Benefits

401K (4% Match, Immediate Vesting)
Accident insurance
Competitive salary
Critical Illness Insurance
Dental Insurance
Employee Assistance Program
Flexible Spending Account
Health & Wellness Program
Health Savings Account
Life & AD&D Insurance
Long Term Disability
Medical Insurance
Paid Time Off
Pet Insurance
Short Term Disability
Vision Insurance

Pre-Employment Screening

Drug Screen and Background Check Required

HealthOne Statement

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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