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Utilization Review Jobs in Dallas, GA (NOW HIRING)

CGI Inc.

Clinical Nurse Auditor

Atlanta, GA · On-site

... utilization review determinations Excellent written communication skills with the ability to prepare detailed, well-supported clinical narratives using proper grammar and documentation standards ...

YO AI Labs

Hospitalist Physician - Remote

Atlanta, GA · Remote

$70 - $100/hr

Experience with utilization review, medical coding, or healthcare quality assurance. * Familiarity with electronic health records and structured clinical data. * Experience working across multiple ...

Harborview-Health-System

RN MDS Director

Sandy Springs, GA · On-site

$110 - $140/hr

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 ...

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All JobsUtilization Review JobsUtilization Review Jobs in Dallas, GA

Utilization Review information

See Dallas, GA salary details

$19

$38

$62

How much do utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for utilization review in Dallas, GA is $38.20, according to ZipRecruiter salary data. Most workers in this role earn between $30.19 and $43.85 per hour, depending on experience, location, and employer.

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 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.

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, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

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

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

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

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

What cities near Dallas, GA are hiring for Utilization Review jobs?

Cities near Dallas, GA with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Dallas, GA as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $79,453 per year, or $38.2 per hour.

Prior Authorization Clinical Pharmacist

Elevance Health

Atlanta, GA • On-site

$114K - $136K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Elevance Health rating

7.5

Company rating: 7.5 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

218th of 315 rated insurance

Job description

Prior Authorization Clinical Pharmacist

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Prior Authorization Clinical Pharmacist is responsible for evaluating and managing the selection and utilization of pharmaceuticals to ensure safe, effective, and cost-efficient medication use. This role supports key clinical pharmacy programs, including Drug Utilization Review (DUR), Drug Information Services (DIS), and formulary management.

How you will make an impact:

  • Researches and synthesizes detailed clinical data related to pharmaceuticals.

  • Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.

  • May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.

  • Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.

  • Prepares information for network physicians.

  • Prepares and presents therapeutic class reviews and drug monographs to the Pharmacy and Therapeutics (P&T) Committee.

  • Provides clinical guidance for therapeutic interventions, dosage conversions, and evidence-based medication use.

  • Develops and communicates drug information and recommendations to network physicians and clinical teams.

Minimum Requirements:

  • Requires BA/BS in Pharmacy.

  • Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires a registered pharmacist.

  • Current unrestricted Pharmacist license in applicable state(s) required.

  • For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Preferred Skills, Capabilities and Experiences:

  • Active, unrestricted license to practice pharmacy as a Registered Pharmacist (RPh) in the state of Kansas highly preferred.

  • PharmD preferred.

  • PBM experience preferred.

  • Prior Authorization experience preferred.

  • Specialty Medication experience preferred.

Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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