... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Cycle, Case Management, Compliance, Finance, HIM, Epic, Physician Advisors, and Executive ...
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care ...
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
... and Case Management in a cooperative effort with other parties which helps address the issues of ... Responsible for the performance of Utilization Review services, including pre-admission ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
... and Case Management in a cooperative effort with other parties which helps address the issues of ... Responsible for the performance of Utilization Review services, including pre-admission ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
... and Case Management in a cooperative effort with other parties which helps address the issues of ... Responsible for the performance of Utilization Review services, including pre-admission ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
... and Case Management in a cooperative effort with other parties which helps address the issues of ... Responsible for the performance of Utilization Review services, including pre-admission ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... case management process. Works as an intermediary between carriers, attorneys, medical care ...
Telephonic Nurse Case Manager
Atlanta, GA · On-site
Responsible for the performance of Utilization Review services, including pre-admission ... case management process. Works as an intermediary between carriers, attorneys, medical care ...
The Registry Utilization Review Nurse (PRN) is responsible for conducting medical necessity reviews ... The UR RN (PRN) will ensure proper use of Case Management Systems and workflows. MINIMUM ...
New
The Registry Utilization Review Nurse (PRN) is responsible for conducting medical necessity reviews ... The UR RN (PRN) will ensure proper use of Case Management Systems and workflows. MINIMUM ...
New
Provide direct oversight to UM manager and clinical review staff. * Establish productivity ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...
Provide direct oversight to UM manager and clinical review staff. * Establish productivity ... Certification in Case Management and/or Utilization Management preferred. WORK SHIFT: Days (United ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance. * Monitor and analyze key performance ...
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance. * Monitor and analyze key performance ...
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance. * Monitor and analyze key performance ...
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance. * Monitor and analyze key performance ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Utilization Review or Care Management experience Preferred Licenses and Certifications * Current ... Case Management Certification (CCM) or American Case Management Association (ACMA) certification ...
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance * Monitor and analyze key performance ...
Quick apply
Work closely with case management, managed care, and patient financial services to streamline utilization review and enhance hospital financial performance * Monitor and analyze key performance ...
Case Manager
$18.75 - $24/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
Case Manager
$18.75 - $24/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
Case Manager
Athens, GA · On-site
$17.50 - $22.50/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
Athens, GA · On-site
$17.50 - $22.50/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
Newnan, GA · On-site
$18 - $23.25/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Case Manager
Newnan, GA · On-site
$18 - $23.25/hr
Medical
Dental
Vision
Retirement
PTO
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Utilization Review Case Manager information
See Georgia salary details
$14.01 - $17.35
3% of jobs
$17.35 - $20.69
1% of jobs
$20.69 - $24.03
6% of jobs
$25.64 is the 25th percentile. Wages below this are outliers.
$24.03 - $27.37
30% of jobs
The median wage is $28.57 / hr.
$27.37 - $30.71
26% of jobs
$31.98 is the 75th percentile. Wages above this are outliers.
$30.71 - $34.04
22% of jobs
$34.04 - $37.38
3% of jobs
$37.38 - $40.72
0% of jobs
$40.72 - $44.06
5% of jobs
$44.06 - $47.40
2% of jobs
$47.40 - $50.74
1% of jobs
$14
$30
$50
How much do utilization review case manager jobs pay per hour?
As of Aug 13, 2026, the average hourly pay for utilization review case manager in Georgia is $30.81, according to ZipRecruiter salary data. Most workers in this role earn between $24.95 and $32.50 per hour, depending on experience, location, and employer.
What are some common challenges utilization review case managers face when coordinating care across multiple departments?
Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.
What is a utilization review case manager?
A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.
What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing medical records, clinical review, patient care evaluation |
Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.
What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?
To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Georgia?
For Utilization Review Case Manager jobs in Georgia, the most frequently searched job titles are:
- Flexible Cvs Utilization Management Nurse
- Registered Nurse Case Management
- Temporary Admission Discharge Nurse
- Flex Schedule Remote Utilization Review Nurse
- Per Diem Remote Chart Review Nurse
- Utilization Review Nurse
- Utilization Management
- Utilization Management Per Diem
- Manager Utilization Management
- Independent Contractor Remote Utilization Management Nurse
What job categories do people searching Utilization Review Case Manager jobs in Georgia look for?
The top searched job categories for Utilization Review Case Manager jobs in Georgia are:
What cities in Georgia are hiring for Utilization Review Case Manager jobs?
Cities in Georgia with the most Utilization Review Case Manager job openings:
Full-time
Posted 14 days ago
Piedmont Healthcare rating
7.1
Based on 466 frontline employees who took The Breakroom Quiz
381st of 887 rated healthcare providers
Job description
ResponsibilitiesProvide 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.QualificationsEducation
- Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required
- 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
- 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
What Piedmont Healthcare employees say
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Benefits
Hours and flexibility
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About Piedmont
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Atlanta, GA, US
Year founded
1905