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Utilization Review Jobs in Georgia (NOW HIRING)

LCMC Health

The Director oversees day-to-day utilization review operations, establishes standardized processes and best practices, and drives organizational alignment to promote cost-effective care. Working ...

UHS

UTILIZATION MANAGEMENT COORDINATOR

GA · On-site

Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network ... Reviews and understands insurance information provided by the Call Center, determines which ...

UHS

UTILIZATION MANAGEMENT COORDINATOR

Sautee, GA

Responsibilities Black Bear Lodge Utilization Management Coordinator Foundations Recovery Network ... Reviews and understands insurance information provided by the Call Center, determines which ...

Alliant Health Solutions

Review Nurse-PA/UM

Atlanta, GA · On-site

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval and precertification reviews for Georgia Fee ...

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Utilization Review information

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$18

$35

$58

How much do utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review 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.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Georgia? The most popular types of Utilization Review jobs in Georgia are:
What are popular job titles related to Utilization Review jobs in Georgia? For Utilization Review jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Georgia look for? The top searched job categories for Utilization Review jobs in Georgia are:
What cities in Georgia are hiring for Utilization Review jobs? Cities in Georgia with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $74,260 per year, or $35.7 per hour.

Manager Utilization Management-Behavioral Health

Piedmont Healthcare Inc.

Atlanta, GA • On-site

Full-time

Posted 10 days ago

Piedmont Healthcare rating

7.1

Company rating: 7.1 out of 10

Based on 466 frontline employees who took The Breakroom Quiz

378th of 887 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
  • Bachelor's Degree in Nursing, Business Administration, Health Administration, Social Work, or a closely related field Required
Work Experience
  • 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
Licenses and Certifications
  • 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

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