The Utilization Management Representative I is responsible for coordinating cases for ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
The Utilization Management Representative I is responsible for coordinating cases for ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
The Utilization Management Representative I is responsible for coordinating cases for ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
The Utilization Management Representative I is responsible for coordinating cases for ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary ...
Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary ...
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary ...
Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary ...
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Previous experience in Utilization Management and/or Appeals Required * Previous Epic experience or Meditech/MIDAS experience Required * Previous experience in prior authorization process Required
Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE
Athens, GA · On-site
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
Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE
Athens, GA · On-site
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
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Travel Utilization Review
Atlanta, GA · On-site
$1.8K - $2.7K/wk
Industry experienced workforce management team * Licensure and certification reimbursement About ... Utilization Review (UR) About AMN Healthcare Revenue Cycle AMN Healthcare is a leading force in the ...
Travel Utilization Review
Atlanta, GA · On-site
$1.8K - $2.7K/wk
Industry experienced workforce management team * Licensure and certification reimbursement About ... Utilization Review (UR) About AMN Healthcare Revenue Cycle AMN Healthcare is a leading force in the ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE
Athens, GA · On-site
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
Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE
Athens, GA · On-site
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
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Utilization Review Clinician
Augusta, GA · On-site
The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that ...
Utilization Review Clinician
Augusta, GA · On-site
The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Utilization Review Clinician
Augusta, GA · On-site
Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued ...
Utilization Review Clinician
Augusta, GA · On-site
Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Working manager who oversees the Utilization Review coordinators * Participate in treatment team meetings, collaborate with physicians, therapist, nurses and pertinent staff * Authorizing entities to ...
Utilization Review Specialist
Decatur, GA · On-site
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Serve as liaison between managed care organizations (MCOs) and clinical staff to ensure timely ...
Utilization Review Specialist
Decatur, GA · On-site
Description The Utilization Review Specialist coordinates insurance authorizations for individual ... Serve as liaison between managed care organizations (MCOs) and clinical staff to ensure timely ...
Utilization Manager information
See Georgia salary details
$32.9K - $42.8K
9% of jobs
$50.1K is the 25th percentile. Wages below this are outliers.
$42.8K - $52.7K
22% of jobs
$52.7K - $62.5K
11% of jobs
The median wage is $68.6K / yr.
$62.5K - $72.4K
14% of jobs
$72.4K - $82.3K
12% of jobs
$88.4K is the 75th percentile. Wages above this are outliers.
$82.3K - $92.1K
13% of jobs
$92.1K - $102K
13% of jobs
$102K - $111.8K
5% of jobs
$111.8K - $121.7K
2% of jobs
$121.7K - $131.6K
0% of jobs
$131.6K - $141.4K
0% of jobs
$32.9K
$76.8K
$141.4K
How much do utilization manager jobs pay per year?
What are the key skills and qualifications needed to thrive as a utilization manager?
What are some common challenges faced by utilization managers, and how can they be addressed?
What is a utilization manager?
A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.
What is the difference between Utilization Manager vs Utilization Coordinator?
| Aspect | Utilization Manager | Utilization Coordinator |
|---|---|---|
| Certifications | Often requires healthcare or case management certifications | May have similar certifications but less emphasis on management |
| Work Environment | Typically in healthcare organizations, overseeing utilization review processes | Supports daily operations, assisting with case documentation and scheduling |
| Employer & Industry Usage | Common in healthcare, insurance, and managed care companies | Found in similar settings, often working under Utilization Managers |
In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 27 days ago
Elevance Health rating
7.7
Based on 351 frontline employees who took The Breakroom Quiz
200th of 304 rated insurance
Job description
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.
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 may contact elevancehealthjobssupport@elevancehealth.com for assistance.
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.
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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