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Utilization Review Rn Jobs in Georgia (NOW HIRING)

LCMC Health

The Director oversees day-to-day utilization review operations, establishes standardized processes ... Active RN license (if clinical background). * Certification in Case Management and/or Utilization ...

Acadia Healthcare

Utilization Specialist

Valdosta, GA

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist

Valdosta, GA · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Georgia

Utilization Review Rn information

See Georgia salary details

$18

$35

$58

How much do utilization review rn jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for utilization review rn in Georgia is $35.70, according to ZipRecruiter salary data. Most workers in this role earn between $28.22 and $41.01 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Georgia as of June 2026, with employment types broken down into 81% Full Time, and 19% Part Time. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $74,260 per year, or $35.7 per hour.
Utilization Mgmt Coord - Behavioral Health, PRN, Macon

Utilization Mgmt Coord - Behavioral Health, PRN, Macon

Piedmont Healthcare Inc.

Macon, GA

Other

Posted 23 days ago

Piedmont Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 455 frontline employees who took The Breakroom Quiz

404th of 877 rated healthcare providers

Job description

OverviewThe purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.Responsibilities

The purpose of this position is to ensure that admitted patients have the appropriate level of care, patient status, authorization status, plan of care and meet medical necessity for the behavioral health services. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensure that patient's payor has the clinical information with which to authorize the behavioral health service and continued stay service to include covered days and associated services.

**ALL PRN'S MUST BE AVAILABLE FOR 6 SHIFTS PER MONTH (3 WEEKDAY SHIFTS AND 3 WEEKEND SHIFTS). DAY SHIFTS ONLY. MUST WORK 1 HOLIDAY IN SPRING/SUMMER AND 1 HOLIDAY IN FALL/WINTER**

QualificationsEducation
  • Bachelor's Degree from an accredited nursing school, B.A/ B.S or Required or
  • Bachelor's Degree in Social Work Required or
  • Master's degree Preferred
Work Experience
  • 2 years of experience in an acute, post-acute, managed care, psychiatric, or revenue cycle Required
  • Previous experience with InterQual and/or MCG guidelines 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
  • Utilization Review or Care Management experience Preferred
Licenses and Certifications
  • Current unrestricted registered nurse (RN) license or LMSW/LCSW, in the state of Georgia. Required or
  • LPC/LMFT also acceptable Required
Additional Licenses and Certifications
  • Case Management Certification (CCM) or American Case Management Association (ACMA) certification Preferred
Business Unit : Company NamePiedmont Healthcare CorporateEmployment Type: OTHER

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