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Utilization Management Jobs in Athens, GA (NOW HIRING)

medmix

Order Management Representative

Flowery Branch, GA · Hybrid

$14.75 - $20/hr

Deliver excellent Order Management based on achieving targets on KPIs for order entry, order ... Utilization of customer portals as necessary for receiving orders, submitting ASNs, invoices and ...

medmix

Order Management Representative

Flowery Branch, GA · Hybrid

$14.75 - $20/hr

Deliver excellent Order Management based on achieving targets on KPIs for order entry, order ... Utilization of customer portals as necessary for receiving orders, submitting ASNs, invoices and ...

SRI Management

Cook

Greensboro, GA · On-site

$12.50 - $16.75/hr

Responsible for enhancing and improving the SRIM Management experience specifically in Artful ... Oversees proper food handling and utilization of all foods to prevent contamination, increase the ...

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All JobsUtilization Management JobsUtilization Management Jobs in Athens, GA

Utilization Management information

See Athens, GA salary details

$37.7K

$86.4K

$157.4K

How much do utilization management jobs pay per year?

As of Jul 27, 2026, the average yearly pay for utilization management in Athens, GA is $86,403.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,300.00 and $100,900.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are popular job titles related to Utilization Management jobs in Athens, GA? For Utilization Management jobs in Athens, GA, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Athens, GA look for? The top searched job categories for Utilization Management jobs in Athens, GA are:
What cities near Athens, GA are hiring for Utilization Management jobs? Cities near Athens, GA with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Athens, GA as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $86,403 per year, or $41.5 per hour.
Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE

Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE

Trinity Health

Athens, GA • On-site

Full-time

Posted 2 days ago

Trinity Health rating

6.5

Company rating: 6.5 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

603rd of 890 rated healthcare providers

Job description

Employment Type:
Full timeShift:
Description:
THIS IS A 1099 POSITION
The Physician Advisor serves as a physician leader responsible for improving clinical documentation accuracy, case mix index (CMI), medical necessity compliance, utilization management, and hospital throughput.
The Physician Advisor works collaboratively with physicians, case management, clinical documentation integrity (CDI), quality, and revenue cycle teams to ensure appropriate patient status determinations, documentation accuracy, regulatory compliance, and optimal use of hospital resources.
This role provides in person, peer-to-peer physician engagement and education to support compliant documentation, reduce denials, decrease avoidable length of stay, and ensure appropriate utilization of hospital services.
Key Responsibilities and Essential Functions
Clinical Documentation & Case Mix
  • Partner with CDI specialists to improve clinical documentation accuracy and completeness
  • Provide physician-to-physician education on documentation requirements related to:
    • Severity of illness
    • Risk of mortality
    • CC/MCC capture
    • DRG assignment
  • Assist with case mix index (CMI) improvement initiatives
  • Review complex cases for documentation opportunities that accurately reflect patient acuity

Utilization Management & Length of Stay Optimization
  • Provide physician guidance for medical necessity determinations
  • Review cases for appropriate inpatient vs observation status
  • Support case management staff with complex utilization reviews
  • Conduct peer-to-peer reviews with payers
  • Collaborate with care management teams to identify and address barriers to timely discharge
  • Work with clinical teams to reduce avoidable length of stay and excess days
  • Participate in daily multidisciplinary rounds and discussions to address throughput challenges and delayed discharges
  • Work with our Internal Medicine Residents to teach them what a Physician Advisor does and how to align and balance patient care with the KPI's the Physician Advisor works on to improve.

Opportunity Days Reduction
  • Review cases with extended length of stay to identify clinical, operational, or documentation barriers contributing to opportunity days
  • Partner with case management, nursing leadership, and service line leaders to address drivers of avoidable hospital days
  • Provide physician leadership in resolving delays related to:
    • Clinical decision-making
    • Documentation gaps
    • Discharge readiness
    • Specialist consultation delays
  • Support hospital initiatives aimed at improving patient flow and capacity management

Denials Prevention & Appeals
  • Review payer denials related to:
    • Medical necessity
    • Level of care
    • DRG downgrades
  • Write and support clinical appeal letters
  • Participate in denials management strategy
  • Identify systemic issues contributing to denials and implement improvement strategies

Physician Engagement & Education
  • Provide education to medical staff on documentation, utilization management, and efficient care delivery
  • Present findings at:
    • Medical staff meetings
    • Service line meetings
    • Quality committees
  • Serve as a physician champion for documentation improvement, medical necessity compliance, and hospital throughput

Quality & Compliance
  • Ensure hospital practices align with:
    • CMS Conditions of Participation
    • Medicare documentation rules
    • Two-midnight rule
    • Utilization review regulations
  • Partner with Quality and Compliance departments to ensure regulatory alignment

Data Review & Performance Improvement
  • Monitor, analyze, and actively strive to improve key hospital performance metrics including, but not limited to:
    • Case Mix Index (CMI)
    • Length of Stay Index (Observed vs Expected LOS and %GMLOS)
    • Opportunity Days
    • Observation rates
    • Medical necessity denial rates
    • CC/MCC capture rate
  • Identify opportunities for clinical, operational, and documentation improvement

Qualifications:
Required
  • MD or DO degree from an accredited institution
  • Board Certified in a recognized medical specialty
  • Active unrestricted medical license to practice medicine in the state of Georgia.
  • Minimum of 5 years clinical practice experience
  • Experience working in hospital-based care
  • Demonstrated leadership, people management, and team building skills
  • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
  • Ability to develop and implement strategic clinical plans
  • Excellent oral and written communication skills
  • Ability to interact effectively with key internal and external constituents using collaboration and customer service skills that promote excellence in the patient experience.
  • Customer service orientation
  • Demonstrated confidence, initiative, and integrity in work practices
  • Goal-directed and well organized
  • High level of dependability and accuracy
  • Ability to work independently
  • Strong negotiation and persuasion skills
  • Adept at conflict management
  • Ability to function within a stressful environment

Strong computer skills and working knowledge of EMR's
  • A broad knowledge base of health care delivery and case management within a managed care environment
  • Comprehensive knowledge of Utilization Review, levels of care, and observation status

Preferred
  • Prior experience as a Physician Advisor, Medical Director, or Utilization Review physician
  • Experience with:
    • Clinical Documentation Integrity (CDI)
    • Utilization Management
    • Revenue cycle operations
    • Denials management
    • Length of stay improvement initiatives
  • Knowledge of:
    • MS-DRG reimbursement
    • Case Mix Index
    • CMS inpatient admission criteria
  • Certification such as:
    • CHCQM-PHYADV (Certified Physician Advisor)
  • Additional advanced degree (MBA, MPH, MMM, etc)

  • Awareness of healthcare reimbursement systems (HMO, PPO, PPS,CMS)

Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

What Trinity Health employees say

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About Trinity Health

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Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Livonia, MI, US

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