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Utilization Review 1099 Jobs in Decatur, GA (NOW HIRING)

Alliant Health Solutions

Review Nurse-PA/UM

Atlanta, GA · On-site

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee ...

Elevance Health

Utilization Management Rep I

Atlanta, GA · On-site

$15.96 - $18/hr

The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...

Elevance Health

Utilization Management Rep I

Atlanta, GA · On-site

$15.96 - $18/hr

The Utilization Management Representative I is responsible for coordinating cases for ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...

New

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Acute Hospital * Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review: * Admission Criteria * Care coordination * Discharge Planning * Utilize InterQual Criteria * Utilize ...

Medlivo

Travel Nurse RN - Case Management

Atlanta, GA · On-site

... utilization review and discharge planning preferred Shift: Days | 8:30 AM - 5:00 PM | 40 hours/week" Medlivo Job ID #KAISJP00253475. Pay package is based on 8 hour shifts and 40 hours per week ...

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All JobsUtilization Review 1099 JobsUtilization Review 1099 Jobs in Decatur, GA

Utilization Review 1099 information

See Decatur, GA salary details

$20

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$67

How much do utilization review 1099 jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization review 1099 in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What is a utilization review 1099?

A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.

What are the key skills and qualifications needed to thrive as a utilization review 1099?

To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.

What are some typical challenges faced by utilization review 1099 contractors, and how can they be managed?

Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.

What is the difference between Utilization Review 1099 vs Utilization Review Nurse?

AspectUtilization Review 1099Utilization Review Nurse
CredentialsVaries; often self-employed or independent contractorsRegistered Nurse (RN) license required
Work EnvironmentRemote or freelance; contract basisHealthcare facilities, insurance companies, or clinics
Employer/Industry UsageFreelance or independent consulting in healthcareHospitals, insurance providers, healthcare organizations
Work FocusReviewing medical necessity for insurance claimsAssessing patient records, making clinical decisions

Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.

What are popular job titles related to Utilization Review 1099 jobs in Decatur, GA?

For Utilization Review 1099 jobs in Decatur, GA, the most frequently searched job titles are:

What job categories do people searching Utilization Review 1099 jobs in Decatur, GA look for?

The top searched job categories for Utilization Review 1099 jobs in Decatur, GA are:

What cities near Decatur, GA are hiring for Utilization Review 1099 jobs?

Cities near Decatur, GA with the most Utilization Review 1099 job openings:

Utilization Review 1099 jobs near you

Review Nurse-PA/UM

Alliant Health Solutions

Atlanta, GA • On-site

Other

Medical, Dental, Life, Retirement, PTO

Re-posted 11 days ago

Job description

Are you a bedside nurse seeking a change from the hospital setting? If you answered "yes", Alliant Health Solutions, a "2025 Best Place to Work and Healthiest Employer", may be the place for you!
Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee-for-Service Medicaid members for the team's defined review types while meeting and exceeding contract expectations. The primary responsibilities of the Nurse Reviewers are listed below.
In this position, the ideal candidate will:
  • Perform reviews of provider prior approval/precertification requests as per PAUM policy and procedures
  • Evaluate initial clinical information and approve cases that meet criteria. Document clearly the rationale for all review decisions using appropriate criteria or nursing judgment
  • Refer cases that do not meet criteria and cannot be approved by InterQual criteria or nursing judgment to a Referral Nurse Coordinator who in turn assures review by a Peer Review Consultant on any case which a nurse cannot approve
  • Consult with the Manager, Supervisor PA/UM, or Medical Directors on issues related to Peer Consultant review decisions or cases requiring physician clarification
  • Participate in quality improvement and peer review activities
  • Maintain confidentiality of review information and medical records in accordance with HIPAA compliance, and Alliant Policy
  • Work in close collaboration with other team members to support the development of new projects and continuous improvement of the overall work process within the team
  • Promote core values of teamwork, professionalism, effective communication skills and positive behaviors
  • Maintain security and confidentiality of all information in accordance with HIPAA laws, URAC regulations, and company policies
  • Demonstrate compliance with the corporate and departmental policies as evidenced by attendance, punctuality, and dress
  • Perform other duties as assigned
Knowledge, skills and abilities required for this position include:
  • Knowledge of ICD-10-CM, CPT codes, and InterQual criteria preferred
  • Knowledge of clinical theory and problem-solving skills
  • Strong organizational skills with ability to demonstrate the work priorities
  • Excellent interpersonal, written, and verbal skills required
  • Knowledge, skill and ability to perform work with considerable independence by use of creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution
  • Computer literate, experience with MS Windows products
  • Ability to type 30-50 words per minute
  • Ability to travel by car or plane to Company locations, customer meetings or other locations as needed
Education, experience and training required and preferred for the position are below:
Required:
  • Registered Nurse, with at least three years of recent clinical experience required
  • Current and unencumbered Georgia nursing license required
Preferred:
  • Utilization Review or Prior Approval Precertification experience

Alliant knows that people thrive when they feel supported, so we offer work/life balance, competitive benefits including medical, dental life, disability, paid-time off, retirement with match and contribution, disability, employee assistance program, parental leave, and other well-being resources. If interested, click the apply icon above to apply.
Alliant Health Group and subsidiaries, dba Alliant Health Solutions ("the Company) is an Equal Opportunity Employer and Drug Free Workplace. In compliance with the American's with Disability Act (ADA) and Amendments Act (ADAAA), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, gender identity, national origin, disability or veteran status. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, please let us know. Likewise, if you are limited in the ability to access or use this online application process and need an alternative method for applying, we will determine an alternative method for you to apply. Please contact 678-527-3000.

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