Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Utilization Review Clinician Opportunity Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Utilization Review Clinician Opportunity Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Utilization Review Clinician Opportunity Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Utilization Review Clinician Opportunity Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility ...
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
Website: The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care ...
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
Medical
Dental
Vision
Retirement
PTO
The Director of Utilization Review is a key member of the Lighthouse Case Management Team who will integrate and coordinate a patient centric therapeutic strategy with a keen focus on clinical ...
Augusta, GA · On-site
$38 - $45/hr
Medical
Dental
Vision
Life
Retirement
PTO
Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review, monthly Triple Check, and care plan conferences * Utilize programs such as PCC, SimpleLTC, NetHealth ...
Quick apply
Augusta, GA · On-site
$38 - $45/hr
Medical
Dental
Vision
Life
Retirement
PTO
Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review, monthly Triple Check, and care plan conferences * Utilize programs such as PCC, SimpleLTC, NetHealth ...
Aiken, SC · On-site
$1.4K - $1.8K/wk
Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director * Contributes to physical therapy related CQI, as requested * Participates in interdisciplinary ...
Aiken, SC · On-site
$1.4K - $1.8K/wk
Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director * Contributes to physical therapy related CQI, as requested * Participates in interdisciplinary ...
Aiken, SC · On-site
Serves as Utilization Review and/or Advisory Board Member as requested by the Administrator/Director * Maintains knowledge base of HomeCare Speech-Language Pathology procedures and regulations as ...
Aiken, SC · On-site
Serves as Utilization Review and/or Advisory Board Member as requested by the Administrator/Director * Maintains knowledge base of HomeCare Speech-Language Pathology procedures and regulations as ...
$1.4K - $1.8K/wk
Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director. * Contributes to physical therapy related CQI, as requested * Participates in interdisciplinary ...
$1.4K - $1.8K/wk
Serves as Utilization Review and/or Advisory Board Member as requested by Administrator/Director. * Contributes to physical therapy related CQI, as requested * Participates in interdisciplinary ...
Serves as Utilization Review and/or Advisory Board Member as requested by the Administrator/Director. * Maintains knowledge base of HomeCare Speech-Language Pathology procedures and regulations as ...
Serves as Utilization Review and/or Advisory Board Member as requested by the Administrator/Director. * Maintains knowledge base of HomeCare Speech-Language Pathology procedures and regulations as ...
$17.64 - $21.21
2% of jobs
$21.21 - $24.78
9% of jobs
$27.22 is the 25th percentile. Wages below this are outliers.
$24.78 - $28.35
21% of jobs
The median wage is $31.24 / hr.
$28.35 - $31.92
23% of jobs
$31.92 - $35.48
13% of jobs
$38.26 is the 75th percentile. Wages above this are outliers.
$35.48 - $39.05
10% of jobs
$39.05 - $42.62
8% of jobs
$42.62 - $46.19
5% of jobs
$46.19 - $49.76
5% of jobs
$49.76 - $53.33
2% of jobs
$53.33 - $56.89
2% of jobs
$17
$34
$56
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.
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.
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.
The most popular types of Utilization Review jobs in Augusta, GA are:
For Utilization Review jobs in Augusta, GA, the most frequently searched job titles are:
The top searched job categories for Utilization Review jobs in Augusta, GA are:
Cities near Augusta, GA with the most Utilization Review job openings:
Other
Medical, Dental, Vision, Retirement, PTO
Posted 13 days ago
Lighthouse Care Center of Augusta has been providing psychiatric services to the CSRA for more than 15 years. Located in Augusta, GA, our 84-bed facility provides a therapeutic setting for those seeking treatment for mental illness. Lighthouse Care Center offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our tenured team includes seasoned medical staff.
The Utilization Review Clinician opportunity is a key member of the Lighthouse Case Management team who will integrate and coordinate clinical content with a keen focus on patient care; ensuring that delivery of high-quality and cost-effective treatment is consistent with the mission, vision, and values of Universal Health Services and in accordance with government regulation, licensing, and accreditation requirements. Under the direction of the UR Manager, the Utilization Review Coordinator is responsible for conducting clinical review of data to determine eligibility respective to pre-certification and continued stay reviews.
Job duties/responsibilities include reviewing clinical content of medical records, participating in treatment team meetings, and collaborating with physicians, therapists, nurses, and pertinent staff on gathering the necessary data to communicate with insurance companies/authorizing entities to ensure initial precertification and continued authorization is achieved. Ensure input of pre-certifications and continued stay reviews into Midas, follow-up on unfinished pre-certifications from the day before, coordinate with the treatment team on any follow-ups necessary, verify insurance coverage at the first of the month, and post patient payments into MS4. Trained in all aspects relative to timely gathering of clinical criteria, communication of clinical criteria, and entry of supporting clinical criteria into computer-based systems, in addition to other job duties.
Benefit highlights include a referral bonus program, challenging and rewarding work environment, competitive compensation & generous paid time off, excellent medical, dental, vision, and prescription drug plans, 401(k) with company match and discounted stock plan, and career development opportunities within UHS and its 300+ subsidiaries!
