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Utilization Management Per Diem Jobs in Georgia (NOW HIRING)

AccordCare

Per Diem Licensed Registered Nurse

Atlanta, GA · On-site

$80/hr

Per Diem / Per Visit Registered Nurse (RN) We are seeking a reliable and detail-oriented Registered ... Ability to work independently and manage visit schedules Why Join Us * Competitive per-visit rates

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Utilization Management Per Diem information

What is a utilization management per diem?

A Utilization Management Per Diem position involves reviewing and evaluating medical services to ensure they are necessary and provided efficiently, typically in a healthcare or insurance setting. 'Per diem' means the employee works on an as-needed or flexible basis rather than a set schedule, providing coverage during busy periods or when regular staff are unavailable. These roles are commonly filled by nurses or healthcare professionals who assess patient care for appropriateness and compliance with policies. Utilization management helps control costs while ensuring patients receive appropriate care.

What is the difference between Utilization Management Per Diem vs Utilization Review Nurse?

AspectUtilization Management Per DiemUtilization Review Nurse
CredentialsRN license, certification in case management or utilization reviewRN license, certification in case management or utilization review
Work EnvironmentPer diem, hospital or insurance settings, flexible shiftsFull-time or part-time, hospital, insurance, or healthcare facilities
Employer UsageUsed for short-term staffing, on-call basisRegular review and approval of patient care, ongoing case management

Utilization Management Per Diem professionals typically work on a flexible, short-term basis, focusing on specific cases or shifts. In contrast, Utilization Review Nurses often hold ongoing roles, managing patient care reviews regularly. Both roles require similar credentials but differ mainly in work setting and employment structure.

How does a utilization management per diem professional typically interact with other healthcare team members during the review process?

Utilization Management Per Diem professionals work closely with physicians, nurses, social workers, and insurance representatives to ensure that patients receive appropriate care while efficiently utilizing healthcare resources. Communication is often conducted through electronic health records, case review meetings, and phone consultations. Collaboration is key, as you may need to gather additional clinical information or clarify care plans to support authorization and coverage decisions. Being proactive and diplomatic in these interactions helps facilitate smoother care transitions and positive patient outcomes.

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

To thrive as a Utilization Management Per Diem nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is commonly required. Excellent analytical thinking, communication, and time-management abilities help you collaborate effectively and make sound, timely decisions. These skills ensure accurate care reviews, regulatory compliance, and efficient patient care coordination in a flexible, part-time work environment.
What are the most commonly searched types of Utilization Management jobs in Georgia? The most popular types of Utilization Management jobs in Georgia are:
What are popular job titles related to Utilization Management Per Diem jobs in Georgia? For Utilization Management Per Diem jobs in Georgia, the most frequently searched job titles are:
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What cities in Georgia are hiring for Utilization Management Per Diem jobs? Cities in Georgia with the most Utilization Management Per Diem job openings:
Utilization Management Per Diem jobs near you

Utilization Management Representative I

Elevance Health

Columbus, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 5 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 351 frontline employees who took The Breakroom Quiz

200th of 304 rated insurance

Job description

Anticipated End Date:

2026-08-21

Position Title:

Utilization Management Representative I

Job Description:

Utilization Management Representative I

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.


The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.

How you will make an impact:

  • Managing incoming calls or incoming post services claims work.

  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Checks benefits for facility based treatment.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

  • Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

  • Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.

  • Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

  • Performs other duties as assigned.

Minimum Requirements:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Inbound call center experience strongly preferred.

  • Medical terminology training and experience in medical or insurance field strongly preferred.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CUS > Care Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

What Elevance Health employees say

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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