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Utilization Review Specialist Jobs in Decatur, GA

Oversee operational readiness for audits, accreditation reviews, licensing inspections, and ... Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.

... reviews, licensing inspections, and regulatory surveys. • Monitor compliance metrics and ... Utilization Management to ensure compliance. • Develop educational resources and deliver ...

Oversee operational readiness for audits, accreditation reviews, licensing inspections, and ... Coordinate with Utilization Management to support their insurance paneling & credentialing efforts.

... reviews, licensing inspections, and regulatory surveys. · Monitor compliance metrics and implement ... with Utilization Management to support their insurance paneling & credentialing efforts.

Pharmacy Supervisor

Smyrna, GA · On-site

$64.75 - $76.25/hr

... utilization review. * Operates as a resolution specialist for all unusual issues with the Pharmacy Department and Shipping departments. * Active as a leader in the company, and an advocate for the ...

Support review and maintenance of tariff classifications (HTS) , customs valuation information, and ... Partner with internal stakeholders to identify opportunities to maximize compliant utilization of ...

New

Pharmacy Supervisor

Smyrna, GA

$64.75 - $76.25/hr

... utilization review. * Operates as a resolution specialist for all unusual issues with the Pharmacy Department and Shipping departments. * Active as a leader in the company, and an advocate for the ...

Pharmacy Supervisor

Smyrna, GA · On-site

$100 - $125/hr

... utilization review. * Operates as a resolution specialist for all unusual issues with the Pharmacy Department and Shipping departments. * Active as a leader in the company, and an advocate for the ...

Showing results 41-60

Utilization Review Specialist information

See Decatur, GA salary details

$15

$31

$52

How much do utilization review specialist jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review specialist in Decatur, GA is $31.18, according to ZipRecruiter salary data. Most workers in this role earn between $21.83 and $39.66 per hour, depending on experience, location, and employer.

What is a utilization review specialist?

Utilization review specialists assess plans for patient care and determine what treatment is appropriate and most cost-effective. They investigate disputed medical claims, coordinate utilization training for the medical staff, analyze electronic medical records, and inform medical staff whether a medical claim is denied, approved, under review, or under appeal. In many cases, the utilization review specialist serves as an advocate for quality patient care, cost reduction, and hospital quality standards.

What are the key skills and qualifications needed to thrive as a utilization review specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare, strong analytical abilities, and typically a degree in nursing, social work, or a related field, often with relevant licensure. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance and regulatory guidelines are essential. Excellent communication, critical thinking, and attention to detail are crucial soft skills for collaborating with providers and advocating for appropriate patient care. These competencies ensure accurate assessments, regulatory compliance, and optimal resource utilization in healthcare settings.

How does a utilization review specialist typically interact with healthcare providers and insurance companies?

Utilization Review Specialists serve as a key liaison between healthcare providers and insurance companies, reviewing patient records to ensure medical necessity and compliance with coverage guidelines. They frequently communicate with physicians and clinical staff to clarify documentation or treatment plans, as well as with insurance representatives to justify or appeal coverage decisions. This collaborative environment requires strong communication skills and a thorough understanding of medical protocols and payer requirements, making teamwork and attention to detail essential aspects of the role.

What is the difference between Utilization Review Specialist vs Claims Reviewer?

AspectUtilization Review SpecialistClaims Reviewer
CredentialsOften requires healthcare-related certifications (e.g., RN, CPC)Typically requires insurance or billing certifications
Work EnvironmentHealthcare settings, insurance companies, hospitalsInsurance companies, healthcare payers, third-party administrators
Job FocusAssess medical necessity and appropriateness of servicesReview insurance claims for accuracy and coverage

While both roles involve reviewing healthcare-related information, the Utilization Review Specialist primarily evaluates the medical necessity of treatments, whereas the Claims Reviewer focuses on verifying insurance claims for correctness and coverage. Both positions require knowledge of healthcare and insurance processes but serve different functions within the healthcare and insurance industries.

How much does a utilization review specialist make in California?

The average salary for a utilization review specialist in California ranges from $60,000 to $80,000 annually, depending on experience, certifications, and location. Salaries may also vary based on the employer and whether the role is full-time or part-time, with some positions offering additional benefits or bonuses.

Is utilization review a good job?

Utilization Review Specialists evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role typically requires strong analytical skills, attention to detail, and knowledge of healthcare regulations, with opportunities for certification and career advancement. It can offer stable employment and a predictable schedule, but job satisfaction depends on individual preferences and work environment.

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

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

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

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

Infographic showing various Utilization Review Specialist job openings in Decatur, GA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $64,864 per year, or $31.2 per hour.

Senior Clinical Specialist, Interventional Solutions, Atlanta, GA

Boston Scientific

Atlanta, GA • On-site

$110K/yr

Full-time

Posted 15 days ago


Boston Scientific rating

8.5

Company rating: 8.5 out of 10

Based on 120 frontline employees who took The Breakroom Quiz

33rd of 546 rated manufacturers


Job description

Additional Location(s): US-GA-Atlanta
Diversity - Innovation - Caring - Global Collaboration - Winning Spirit - High Performance
At Boston Scientific, we'll give you the opportunity to harness all that's within you by working in teams of diverse and high-performing employees, tackling some of the most important health industry challenges. With access to the latest tools, information and training, we'll help you in advancing your skills and career. Here, you'll be supported in progressing - whatever your ambitions.
About the role:
As an Interventional Solutions Senior Clinical Specialist, you will play a critical role in advancing patient care through clinical expertise, customer education and procedural support across Boston Scientific's comprehensive Interventional Solutions portfolio. In this field-based position, you will partner closely with physicians, catheterization laboratory staff and cross-functional teams to drive clinical adoption, support market development initiatives and expand utilization of innovative coronary therapies.
This role requires advanced clinical acumen, strong customer relationships and the ability to influence clinical practice through education, training and consultative support. You will serve as a trusted clinical expert within your territory while contributing to business growth and improving patient outcomes.
Within Interventional Solutions, we design, develop and manufacture technologies that diagnose and treat coronary artery disease and other cardiovascular conditions, including acute myocardial infarction. Our portfolio includes drug-eluting stents, drug-coated balloons, bare-metal stents, catheters, balloons, guidewires, coronary atherectomy systems and coronary intravascular ultrasound (IVUS). Supported by a robust portfolio and innovation pipeline, we continue to invest in advancing interventional therapies that improve outcomes for patients around the world.
Your responsibilities will include:
• Execute regional clinical, sales and service strategies to support market growth and improve customer experience.
• Serve as a primary clinical resource for case coverage, product utilization, troubleshooting and customer education.
• Provide procedural support during coronary interventions and advise physicians on clinical applications, techniques and best practices associated with Interventional Solutions products.
• Educate customers on the safe and effective use of company products through presentations, in-services, hands-on training and procedural support.
• Build and maintain strong relationships with physicians, catheterization laboratory personnel and key stakeholders within assigned accounts.
• Support product launches and adoption of specialty products through targeted clinical education and training initiatives.
• Identify opportunities to increase product utilization and collaborate with sales partners to execute account growth strategies.
• Assist in the development of physician champions and support engagement with key opinion leaders within the territory.
• Provide guidance and mentorship to newer Clinical Specialists and assist with onboarding and field training activities.
• Support inventory management activities, including consignment inventory tracking, audits, product returns and expired product management.
• Ensure timely collection and reporting of required procedural and clinical documentation.
• Maintain compliance with all company policies, quality standards and regulatory requirements.
Qualifications:
Required qualifications:
• BA/BS required or equivalent work experience.
• Minimum of 4 years' experience in medical device sales, healthcare, clinical cardiology or a related clinical field.
• Ability to work flexible hours and travel as required.
Preferred qualifications:
• Experience supporting coronary interventions and advanced interventional cardiology technologies, including intravascular imaging and coronary atherectomy.
• Demonstrated success developing customer relationships and expanding product utilization within assigned accounts.
• Experience mentoring or training clinical or commercial team members.
• Strong technical aptitude with the ability to communicate complex clinical and product information.
• Strong business acumen, communication and problem-solving skills; advanced degree in health care, business or a related discipline preferred.
Requisition ID: 633326
The anticipated annualized base amount or range for this full time position will be $110,000, plus variable compensation governed by the Sales Incentive Compensation Plan (which includes certain annual non-discretionary incentives based on predetermined objectives) as well as the value of core and optional benefits offered at BSC, which can be reviewed at www.bscbenefitsconnect.com. Actual compensation will be commensurate with demonstrable level of experience and training, pertinent education including licensure and certifications, and other relevant business or organizational needs.
For MA positions: It is unlawful to require or administer a lie detector test for employment. Violators are subject to criminal penalties and civil liability.
Boston Scientific transforms lives through innovative medical technologies that improve the health of patients around the world. As a global medical technology leader for more than 45 years, we advance science for life by providing a broad range of high-performance solutions that address unmet patient needs and reduce the cost of healthcare. Our portfolio of devices and therapies helps physicians diagnose and treat complex cardiovascular, respiratory, digestive, oncological, neurological and urological diseases and conditions. Learn more at www.bostonscientific.com and follow us on LinkedIn.
Boston Scientific maintains a prohibited substance free workplace. Pursuant to Va. Code § 2.2-4312 (2000), Boston Scientific is providing notification that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the workplace and that violations will result in disciplinary action up to and including termination.
Please be advised that certain US based positions, including without limitation field sales and service positions that call on hospitals and/or health care centers, require acceptable proof of COVID-19 vaccination status. Candidates will be notified during the interview and selection process if the role(s) for which they have applied require proof of vaccination as a condition of employment. Boston Scientific continues to evaluate its policies and protocols regarding the COVID-19 vaccine and will comply with all applicable state and federal law and healthcare credentialing requirements. As employees of the Company, you will be expected to meet the ongoing requirements for your roles, including any new requirements, should the Company's policies or protocols change with regard to COVID-19 vaccination.
Among other requirements, Boston Scientific maintains specific prohibited substance testing requirements for safety-sensitive positions. This role is deemed safety-sensitive and, as such, candidates will be subject to a drug test as a pre-employment requirement. The goal of the drug testing is to increase workplace safety in compliance with the applicable law.

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About Boston Scientific

Sourced by ZipRecruiter

As a leader in medical science for more than 40 years, we are committed to solving the challenges that matter most - united by a deep caring for human life. Our mission to advance science for life is about transforming lives through innovative medical solutions that improve patient lives, create value for our customers, and support our employees and the communities in which we operate. Now more than ever, we have a responsibility to apply those values to everything we do - as a global business and as a global corporate citizen.

Industry

Medical equipment and supplies manufacturing, manufacturing and construction

Company size

10,000+ Employees

Headquarters location

Marlborough, MA, US

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