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Utilization Reviewer Jobs in Georgia (NOW HIRING)

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Job Title Utilization Management Nurse The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

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 ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Georgia

Utilization Reviewer information

See Georgia salary details

$26.2K

$32.1K

$37.2K

How much do utilization reviewer jobs pay per year?

As of Aug 7, 2026, the average yearly pay for utilization reviewer in Georgia is $32,080.00, according to ZipRecruiter salary data. Most workers in this role earn between $28,700.00 and $35,500.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
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Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 88% Full Time, 9% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $32,080 per year, or $15.4 per hour.

D107 - C&A MH Crisis - Utilization Management Coordinator

riveredge

Macon, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Utilization Management Coordinator

 

Company Overview:

At River Edge Behavioral Health in Macon, GA, employees are expected to develop meaningful relationships with patients, establishing trust and making a difference in the lives of clients and their families. We believe in supporting our team as well as our clients with our comprehensive benefits package and a supportive work culture, including health, dental, and vision benefits, paid vacation, retirement plans, and more.

Position Overview:

The Utilization Management Coordinator role is focused on ensuring clients receive the appropriate level of behavioral health care while maintaining compliance with medical necessity, authorization, and documentation requirements. The position combines utilization review, care coordination, insurance authorization management, and administrative oversight within behavioral health services.

 

Location/Schedule:

3575 Fulton Mill Road, Macon, GA. 

 

Key Responsibilities

  • Create Connects batch files 
  • Retrieve and process response files from Beacon’s SFTP site 
  • Work Connects documents in rejected, denied, hold, no CID, multi-final payer and status appropriately 
  • Review discharge connects and flip to UM complete 
  • Manage and process BHL CSU authorizations and update Carelogic 
  • Review and process AC file for BHL CSU authorization 
  • Complete State Discharge process for Fulton locations 
  • Create PTRF referral via Beacon authorization request 
  • Review and process Connects documents in UM review 

Qualifications

  • High School Diploma (Bachelors in helping profession such as social work, community counseling, counseling psychology, or criminology preferred) 
  • 1-3 years of utilization management experience 

Additional Benefits:

  • Flexible spending accounts
  • 11 Paid holidays
  • Voluntary Life Insurance

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