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Utilization Management Jobs in Duluth, GA (NOW HIRING)

Wellstar Health System

UM Manager-Onsite

Roswell, GA · On-site

... Utilization Management program; assumes responsibility for implementing standards of practice, evidenced based medical guidelines, departmental policies and procedures, and maintaining and guiding ...

New

Wellstar Health System

UM Manager-Onsite

Marietta, GA · On-site

Resource for Utilization Review within continuum of care.* Sustain professional competency; pursue clinical skill development and specialty certification.* Facilitate case management across the ...

Wellstar Health System

UM Manager-Onsite

Marietta, GA · On-site

... Utilization Management program; assumes responsibility for implementing standards of practice, evidenced based medical guidelines, departmental policies and procedures, and maintaining and guiding ...

Managed Care Group

Be Seen First

Sr. Director, Managed Care Strategy

Duluth, GA · On-site

$110K - $114K/yr

... and utilization management (UR/UM) processes. This role does not involve people‐management responsibilities but requires deep domain expertise and the ability to influence product direction and ...

Integrated Resources INC

Case Manager

Alpharetta, GA · Remote

$19.50 - $25.25/hr

Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience. She is also looking for candidates with inpatient, outpatient, and ...

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All JobsUtilization Management JobsUtilization Management Jobs in Duluth, GA

Utilization Management information

See Duluth, GA salary details

$35.9K

$82.4K

$150K

How much do utilization management jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization management in Duluth, GA is $82,362.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,400.00 and $96,200.00 per year, depending on experience, location, and employer.

What is utilization management?

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 the key skills and qualifications needed to thrive in utilization management, 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 degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Duluth, GA?

The most popular types of Utilization Management jobs in Duluth, GA are:

What are popular job titles related to Utilization Management jobs in Duluth, GA?

For Utilization Management jobs in Duluth, GA, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Duluth, GA look for?

The top searched job categories for Utilization Management jobs in Duluth, GA are:

What cities near Duluth, GA are hiring for Utilization Management jobs?

Cities near Duluth, GA with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Duluth, GA as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $82,362 per year, or $39.6 per hour.

Manager Utilization Management-Behavioral Health

Fayette Chamber of Commerce

Atlanta, GA • On-site

$110 - $170/hr

Other

Posted 16 days ago

Job description

Responsibilities

Provide system-level leadership and operational oversight of the Behavioral Health Utilization Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple Behavioral Health programs, including inpatient, ED-based, and specialty BH services. Responsible for ensuring consistent, compliant, and effective UR operations that support appropriate level-of-care determination, medical necessity, denial prevention, and financial performance. Serves as a primary point of contact and collaborative partner with multiple system teams, including but not limited to Revenue Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive Leadership, to align utilization practices with regulatory, payer, and organizational expectations.


Qualifications
Education

  • Bachelor’s Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required


Work Experience

  • 5 years of experience in Behavioral Health Utilization Management and Utilization Review processes using medical necessity criteria (InterQual and/or Milliman).

  • 2 years Experience requirement above, to include, 2 years of demonstrated leadership or management experience in a hospital, medical practice, or other healthcare setting Required

  • Experience working in a system-level or multi-site environment Preferred


Licenses and Certifications

  • RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required or

  • LPC-Licensed Professional Counselor Required or

  • LMSW - Licensed Medical Social Worker - State Licensure Required or

  • LCSW- License Clinical Social Worker Required or

  • Licensed Marriage and Family Therapist (LMFT) Required

  • IQCI Certification Required


Business Unit : Company Name


Piedmont Healthcare Corporate

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