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Utilization Management Non Clinical Jobs in Georgia

LCMC Health

Working collaboratively with clinical, operational, and revenue cycle leadership, this position ... In conjunction with the Corp VP, Case Management & Utilization, develop and implement a system-wide ...

Clarvida - Georgia

Utilization Manager

Savannah, GA · On-site

Utilization Manager LCSW, LPC, LMSW, LAPC As our Utilization Manager, you will coordinate Utilization Management functions for the agency. * Trains staff on proper documentation, including ...

Clarvida - Georgia

Utilization Manager

Columbus, GA · On-site

Utilization Manager LCSW, LPC, LMSW, LAPC As our Utilization Manager, you will coordinate Utilization Management functions for the agency. * Trains staff on proper documentation, including ...

Clarvida - Georgia

Utilization Manager

Augusta, GA · On-site

Utilization Manager LCSW, LPC, LMSW, LAPC As our Utilization Manager, you will coordinate Utilization Management functions for the agency. * Trains staff on proper documentation, including ...

UHS

UTILIZATION MANAGEMENT COORDINATOR

GA · On-site

Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network ... Highly talented Clinical Team * Diverse Clientele Qualifications Essential Duties and ...

UHS

UTILIZATION MANAGEMENT COORDINATOR

Sautee, GA

Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network ... Highly talented Clinical Team * Diverse Clientele Qualifications Essential Duties and ...

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Utilization Management Non Clinical information

Can you do a utilization review without being a nurse?

Utilization Management Non Clinical roles typically do not require a nursing license, as they focus on reviewing medical necessity and appropriateness of services based on guidelines and policies. These positions often require strong analytical skills, knowledge of healthcare policies, and sometimes certifications like Certified Professional in Healthcare Quality (CPHQ), but do not usually mandate nursing credentials.

Which non-clinical healthcare jobs pay the most?

In non-clinical healthcare roles, positions such as healthcare administrators, health information managers, and utilization management directors tend to have the highest salaries. These roles often require advanced degrees, certifications, and strong management or technical skills, and they typically offer six-figure compensation depending on experience and location.

What jobs pay 4000 a week without a degree?

Utilization Management Non Clinical roles typically do not pay $4,000 a week without a degree, as they often require healthcare knowledge or certifications. High-paying jobs that can reach this level without a degree include certain sales positions, real estate brokers, or specialized trades like commercial pilots or skilled trades, which may require licenses or experience. Most roles paying this amount without a degree involve sales, entrepreneurship, or skilled labor with relevant certifications or experience.

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.

What is an example of a non-clinical position?

A non-clinical position in utilization management, such as Utilization Management Non-Clinical roles, involves reviewing medical records and insurance policies to determine coverage and appropriateness of care without direct patient interaction. These roles typically require knowledge of healthcare policies, strong analytical skills, and familiarity with healthcare management systems.
What are popular job titles related to Utilization Management Non Clinical jobs in Georgia? 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:
What cities in Georgia are hiring for Utilization Management Non Clinical jobs? 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 July 2026, with employment types broken down into 100% Full Time. Highlights an 89% In-person, and 11% Remote job distribution.
Utilization Management Nurse

Utilization Management Nurse

HealthOne Alliance

Dalton, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Job description

MISSION
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.
VALUES
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 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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