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Utilization Manager Jobs in Villa Rica, GA (NOW HIRING)

Kaiser Permanente

Coord, Patient Care

Atlanta, GA · On-site

$16.75 - $22/hr

Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management.

Wellstar Health System

UM Team Lead RN- Onsite

Mableton, GA · On-site

$31 - $41.75/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Wellstar Health System

UM Team Lead RN- Onsite

Vinnings, GA · On-site

$31.75 - $43/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Wellstar Health System

UM Team Lead RN- Onsite

Kennesaw, GA · On-site

$31.50 - $42.50/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Wellstar Health System

UM Team Lead RN- Onsite

Marietta, GA · On-site

$32.25 - $43.50/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Wellstar Health System

UM Team Lead RN- Onsite

Austell, GA · On-site

$31 - $42/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Wellstar Health System

UM Team Lead RN- Onsite

Smyrna, GA · On-site

$33.25 - $45/hr

This includes utilization management, patient advocacy, and monitoring quality indicators to demonstrate outcomes for the team resulting from the service provided. Collaborates with all team members ...

Kaiser Permanente

RN, Specialty Care Review

Atlanta, GA · On-site

$80 - $100/hr

Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management.

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Villa Rica, GA

Utilization Manager information

See Villa Rica, GA salary details

$34K

$79.4K

$146.2K

How much do utilization manager jobs pay per year?

As of Sep 9, 2026, the average yearly pay for utilization manager in Villa Rica, GA is $79,441.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,900.00 and $95,600.00 per year, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound 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.

More about Utilization Manager jobs

What job categories do people searching Utilization Manager jobs in Villa Rica, GA look for?

The top searched job categories for Utilization Manager jobs in Villa Rica, GA are:

What cities near Villa Rica, GA are hiring for Utilization Manager jobs?

Cities near Villa Rica, GA with the most Utilization Manager job openings:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Villa Rica, GA as of August 2026, with employment types broken down into 82% Full Time, 17% Part Time, and 1% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $79,441 per year, or $38.2 per hour.

Access & Reimbursement Manager

Atlanta, GA • On-site

The Lockwood Group, LLC
See more jobs at The Lockwood Group, LLCexternal

Full-time

Posted 5 days ago

Job description

About Stratis Group: Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand's lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics.
Summary: In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area. (Cardiovascular).
The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE). As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role.
In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.
Additional responsibilities include:
  • Manage daily activities that support appropriate patient access to our client's products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
  • Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
  • Provide in-person customer visits.
  • Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
  • Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
  • Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
  • Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
  • Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.

Desired Job Requirements:
  • 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
  • 4-year degree in related field or equivalent experience
  • Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
  • The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
  • Solution oriented mindset, strong business acumen, & strong analytic capabilities
  • Experience and understanding of Retail Pharmacies & Specialty Pharmacies
  • Demonstrated ability to educate offices on access processes and issue resolution
  • Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
  • Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
  • Advanced knowledge of medical insurance terminology
  • Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
  • Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
  • Ability to manage ambiguity & problem solve
  • Prepare and submit appropriate expense reports in a timely fashion
  • Valid Driver's License

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