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Utilization Review Assistant Jobs in Atlanta, GA

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Assist with denial prevention, appeals, and retrospective reviews when necessary.Maintain patient ...

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Initiate and complete the formal appeal process for denied admissions or continued stay. * Assist ...

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Initiate and complete the formal appeal process for denied admissions or continued stay. Assist the ...

Responsible for the performance of Utilization Review services, including pre-admission ... May assist in training/orientation of new staff as requested. Monitors functions assigned to non ...

Responsible for the performance of Utilization Review services, including pre-admission ... May assist in training/orientation of new staff as requested. Monitors functions assigned to non ...

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Utilization Review Assistant information

See Atlanta, GA salary details

$10

$30

$62

How much do utilization review assistant jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review assistant in Atlanta, GA is $30.64, according to ZipRecruiter salary data. Most workers in this role earn between $17.37 and $37.60 per hour, depending on experience, location, and employer.

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What are the most commonly searched types of Utilization Review jobs in Atlanta, GA? The most popular types of Utilization Review jobs in Atlanta, GA are:
What cities near Atlanta, GA are hiring for Utilization Review Assistant jobs? Cities near Atlanta, GA with the most Utilization Review Assistant job openings:
Infographic showing various Utilization Review Assistant job openings in Atlanta, GA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $63,721 per year, or $30.6 per hour.

Utilization Review Specialist

Positive Impact Health Centers INC

Decatur, GA โ€ข On-site

Full-time

Posted 11 days ago


Job description

Description

ย The Utilization Review Specialist coordinates insurance authorizations for individual therapy and IOP ย services, ensuring clients receive appropriate and timely care. This role works closely with clinical staff, ย psychiatry, and payors to gather documentation, review medical necessity, and support treatment ย planning. Strong communication, attention to detail, and knowledge of behavioral health services are ย essential. The specialist plays a key role in supporting client recovery and care continuity within the ย Emotional Wellness & Recovery team. ย 

Requirements

ย This position description should not be interpreted as all inclusive, it may be updated as funding ย deliverables, clinical/agency guidelines, and CDC guidelines change. ย It is intended to identify the major ย responsibilities and requirements of this position. ย The incumbents may be requested to perform job related responsibilities and tasks other than those stated in this position description. ย Essential Duties, Tasks, and Responsibilities: ย  Serve as liaison between managed care organizations (MCOs) and clinical staff to ensure timely ย authorizations for mental health and substance use services. ย  Conduct pre-certification, concurrent, discharge, and retrospective reviews; initiate appeals and ย peer reviews as needed. ย  Monitor patient length of stay and communicate updates or issues to clinical and medical staff ย to support appropriate care planning. ย  Ensure accurate and timely documentation of all utilization reviews, determinations, and ย communications in the electronic medical record (EMR) system. ย  Maintain current knowledge of payer requirements and apply clinical review criteria to ย determine medical necessity and service appropriateness. ย  Collaborate with the billing team to ensure alignment between clinical documentation and ย reimbursement processes. ย  Participate in regular audits of client charts and documentation, including monthly spot checks, ย to ensure compliance with payer and agency standards. ย  Support Quality Management efforts by participating in chart audits, data collection, and ย performance improvement reviews. ย  Assist with enrolling clients in Patient Assistance Programs (PAPs) to support access to ย medications and services. ย  Assist in staff training and education related to documentation standards, continued stay ย criteria, and medical necessity guidelines. ย  Work as part of a multidisciplinary team to support care coordination and ensure efficient, high quality service delivery. ย  Collaborate with Quality Management and department leadership to report on utilization ย trends, denials, appeals, and service quality metrics. ย  Initiate and manage appeals for denied services, including coordinating peer review calls and ย submitting required documentation. ย  Perform other duties as assigned to support department operations and quality care delivery.ย 


ย MINIMUM QUALIFICATIONS & EXPERIENCE : ย  Minimum of 2 years' experience in behavioral health, substance use treatment, or related ย clinical setting. ย  Previous experience in utilization review, insurance authorization, or care management strongly ย preferred. ย  Demonstrated ability to interpret and apply ASAM criteria to clinical documentation. ย  Experience working with insurance payers and understanding of medical necessity ย requirements. ย  Familiarity with ICD-10 codes and behavioral health diagnosis documentation. ย  Proven ability to collaborate within a multidisciplinary team, including clinical and administrative ย staff. ย  Experience conducting chart audits and participating in quality management or compliance ย reviews. ย  Proficiency in electronic medical record (EMR) systems and accurate, timely documentation. ย  ย ย Strong problem-solving skills and the ability to manage multiple priorities in a fast-paced ย environment.ย 


ย PREFERRED KNOWLEDGE, SKILLS, ABILITIES & OTHER APTITUDES (KSAOs): ย Knowledge, Skills, Abilities, and Other Aptitudes (KSAOs):ย 


ย LICENSE/LICENSURE: ย  LSCW, LMHC or LMFT LMHC, or RN highly desiredย 


ย TRAVEL: ย ย  Local travel between PIHC sites and to and from community agencies will be required. ย  Occasional travel to events for training and promotion of salient services to AIDS Service ย Organizations. ย Occasional evening and weekend work is required and working greater ย than 40 hours per week may be required.


ย ย PHYSICAL DEMANDS ย  The physical demands described here are representative of those that must be met by ย an employee to successfully perform the essential functions of this job. ย Reasonable ย accommodation may be made to enable individuals with disabilities to perform the ย essential functions. ย ย ย  While performing the duties of this job, the employee is frequently required to sit and ย talk or hear. ย The employee is occasionally required to walk, use hands to finger, handle, ย or operate computers, objects, tools, or controls and reach with hands and arms. ย  The employee must occasionally lift and/or move up to 40 pounds. ย Specific vision ย abilities required by this role include close vision and the ability to adjust focus. ย ย