... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate ...
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate ...
Manager Utilization Management-Behavioral Health
Atlanta, GA · On-site
$110 - $170/hr
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate ...
Manager Utilization Management-Behavioral Health
Atlanta, GA · On-site
$110 - $170/hr
... Review (UR) and Utilization Management (UM) processes across two hospital campuses and multiple ... Certifications * RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
RN Case Manager
Atlanta, GA · On-site
$85K - $95K/yr
Registered Nurse - RN Case Manager (Direct Hire) Shift: 8-hour morning-afternoon Location is North ... This role partners closely with physicians, patients/families, nursing, utilization review, and the ...
New
Quick apply
RN Case Manager
Atlanta, GA · On-site
$85K - $95K/yr
Registered Nurse - RN Case Manager (Direct Hire) Shift: 8-hour morning-afternoon Location is North ... This role partners closely with physicians, patients/families, nursing, utilization review, and the ...
New
Wellstar North Fulton Hospital, Inc. in Georgia seeks a Utilization Management (UM) Nurse to conduct medical necessity reviews, coordinate care transitions, and collaborate with physicians and payers.
Wellstar North Fulton Hospital, Inc. in Georgia seeks a Utilization Management (UM) Nurse to conduct medical necessity reviews, coordinate care transitions, and collaborate with physicians and payers.
Review Nurse, Pediatric Review
Atlanta, GA · On-site
$65 - $90/hr
... and Utilization Review Contract (MMURS). The Pediatric Review Nurse reviews inputs accurate data ... Registered Nurse, with minimum of three years of recent clinical pediatric experience * Current ...
Review Nurse, Pediatric Review
Atlanta, GA · On-site
$65 - $90/hr
... and Utilization Review Contract (MMURS). The Pediatric Review Nurse reviews inputs accurate data ... Registered Nurse, with minimum of three years of recent clinical pediatric experience * Current ...
Registered Nurse Case Manager
Riverdale, GA · On-site
$70 - $100/hr
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
Registered Nurse Case Manager
Riverdale, GA · On-site
$70 - $100/hr
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor 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: monitor 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: monitor the use of hospital resources and services to ensure appropriate care ...
Wellstar North Fulton Hospital, Inc. in Georgia seeks a Utilization Management (UM) Nurse to conduct medical necessity reviews, coordinate care transitions, and collaborate with physicians and payers.
Wellstar North Fulton Hospital, Inc. in Georgia seeks a Utilization Management (UM) Nurse to conduct medical necessity reviews, coordinate care transitions, and collaborate with physicians and payers.
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor 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: monitor 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: monitor 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: monitor the use of hospital resources and services to ensure appropriate care ...
The UM Nurse will perform utilization review every day by looking at all new admissions, all ... UM RN monitors post-discharge, prebill accounts that do not have an authorization on file, ALOS ...
The UM Nurse will perform utilization review every day by looking at all new admissions, all ... UM RN monitors post-discharge, prebill accounts that do not have an authorization on file, ALOS ...
The UM Nurse will perform utilization review every day by looking at all new admissions, all ... UM RN monitors post-discharge, prebill accounts that do not have an authorization on file, ALOS ...
The UM Nurse will perform utilization review every day by looking at all new admissions, all ... UM RN monitors post-discharge, prebill accounts that do not have an authorization on file, ALOS ...
RN MDS Nurse
$35 - $42.50/hr
Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... Active RN license in good standing in the state of practice * Experience in skilled nursing and ...
Quick apply
RN MDS Nurse
$35 - $42.50/hr
Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... Active RN license in good standing in the state of practice * Experience in skilled nursing and ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... management, case management, utilization review and clinical quality improvement experience ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... management, case management, utilization review and clinical quality improvement experience ...
Utilization Review Rn information
See Atlanta, GA salary details
$20.57 - $24.74
2% of jobs
$24.74 - $28.90
9% of jobs
$31.74 is the 25th percentile. Wages below this are outliers.
$28.90 - $33.06
21% of jobs
The median wage is $36.43 / hr.
$33.06 - $37.22
23% of jobs
$37.22 - $41.38
13% of jobs
$44.62 is the 75th percentile. Wages above this are outliers.
$41.38 - $45.54
10% of jobs
$45.54 - $49.70
8% of jobs
$49.70 - $53.86
5% of jobs
$53.86 - $58.02
5% of jobs
$58.02 - $62.18
2% of jobs
$62.18 - $66.35
2% of jobs
$20
$40
$66
How much do utilization review rn jobs pay per hour?
As of Sep 6, 2026, the average hourly pay for utilization review rn in Atlanta, GA is $40.66, according to ZipRecruiter salary data. Most workers in this role earn between $32.12 and $46.68 per hour, depending on experience, location, and employer.
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.
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.
What is the difference between Utilization Review Rn vs Case Manager?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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 get into utilization review as a registered nurse?
To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.
What are the most commonly searched types of Utilization Review Rn jobs in Atlanta, GA?
The most popular types of Utilization Review Rn jobs in Atlanta, GA are:
What are popular job titles related to Utilization Review Rn jobs in Atlanta, GA?
For Utilization Review Rn jobs in Atlanta, GA, the most frequently searched job titles are:
- Utilization Review Nurse
- Clinical Review Nurse Remote
- Home Based Utilization Review Nurse
- Cvs Utilization Management Nurse
- Remote Utilization Management Nurse
- Night Utilization Review Nurse
- Temporary Utilization Review Nurse
- Remote Utilization Review Social Worker
- Remote Utilization Review Nurse
- Weekend Physician Advisor Utilization Review
What job categories do people searching Utilization Review Rn jobs in Atlanta, GA look for?
The top searched job categories for Utilization Review Rn jobs in Atlanta, GA are:
What cities near Atlanta, GA are hiring for Utilization Review Rn jobs?
Cities near Atlanta, GA with the most Utilization Review Rn job openings:
Full-time
Re-posted 9 days ago
Piedmont Healthcare rating
7.1
Based on 468 frontline employees who took The Breakroom Quiz
379th of 898 rated healthcare providers
Job description
Responsibilities
Provide 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.
Qualifications
Education
Business Unit : Company Name
Piedmont Healthcare Corporate
Provide 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.
Qualifications
Education
- 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
Business Unit : Company Name
Piedmont Healthcare Corporate
What Piedmont Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Piedmont
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Atlanta, GA, US
Year founded
1905