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Utilization Reviewer Jobs in Athens, GA (NOW HIRING)

Willowbrook Hospice LLC

Hospice Social Worker

Winder, GA · On-site

... Utilization Review programs. · Work as a team member at all times. · Maintain and uphold the Hospice Code of Ethics. III. JOB CONDITIONS Job requires the ability to: · Access patients' homes and ...

Encompass Health Corporation

Case Manager

Athens, GA · On-site

$17.50 - $22.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Athens, GA · On-site

$19.25 - $24.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Corvel

Medical Case Manager I

Athens, GA

$63K - $95K/yr

A cost containment background, such as utilization review or managed care is helpful * Strong interpersonal, time management, and organizational skills * Computer proficiency and technical aptitude ...

Oak St. Health

Grad Pharmacist

Hull, GA · On-site

$14 - $17.25/hr

... drug utilization review (DUR), pharmacy professional standards such as corresponding responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Athens, GA

Utilization Reviewer information

See Athens, GA salary details

$29.9K

$36.7K

$42.5K

How much do utilization reviewer jobs pay per year?

As of Aug 9, 2026, the average yearly pay for utilization reviewer in Athens, GA is $36,685.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,800.00 and $40,600.00 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.
More about Utilization Reviewer jobs
What job categories do people searching Utilization Reviewer jobs in Athens, GA look for? The top searched job categories for Utilization Reviewer jobs in Athens, GA are:
What cities near Athens, GA are hiring for Utilization Reviewer jobs? Cities near Athens, GA with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Athens, GA as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 13% Part Time, and 1% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $36,685 per year, or $17.6 per hour.

Utilization Management Coordinator

Ridgeview Institute Monroe

Monroe, GA

$25 - $28/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

JOIN OUR TEAM AS A FULL-TIME UTILIZATION MANAGEMENT COORDINATOR!

Your Work Matters How will you make a difference?

Are you an empathetic and dedicated professional seeking to positively impact the mental well-being of individuals? Your opportunity awaits at Ridgeview Institute Monroe!

As a Utilization Management Coordinator, you'll be an integral part of our treatment team, providing continuous care, supervision, and positive role modeling to patients across various age groups from adolescent to geriatrics. Working under the guidance of a Utilization Management Coordinator, you'll contribute to creating a therapeutic environment that fosters patient support and well-being.

If you are passionate about mental health care and ready to make a meaningful difference in the lives of patients, join us at Ridgeview Institute Monroe. Here you will be a crucial member of our dynamic and compassionate healthcare team, where your dedication as a Utilization Management Coordinator (UM) will positively impact the overall treatment experience for our diverse patient population.

  1. Review the treatment plan and advocate for additional services as indicated.
  2. Promote effective use of resources for patients.
  3. Ensure that patient rights are upheld.
  4. Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the team.
  5. Collaborate with the treatment team regarding continued stay and discharge planning issues.
  6.  Advocate that the patient is placed in the appropriate level of care and program.
  7. Interface with program staff to facilitate a smooth transition at the time of transfer or discharge.
  8. Maintain documentation related to case management activities.
  9.  Assure tracking of insurance reviews, and that reviews are completed in a timely      manner.   
  10.   Maintain statistical reports and prepare documentation of significant findings.

Your Experience Matters What we’re looking for:

  • Education: Bachelor’s or Master’s degree from an accredited college or university in social work, mental health, nursing, or related degree preferred.
  • Experience:  A minimum of two (2) years’ experience in a healthcare setting or managed care company, with experience in patient assessment, treatment planning, utilization management, and/or case management.

Your Care Matters What we provide for our team:

  • 401(k) + matching
  • Health insurance
  • 100% company-paid life insurance coverage up to 2x your annual salary
  • Vision insurance
  • Dental insurance
  • 100% company-paid short and long term disability insurance
  • Paid time off
  • Paid Holidays
  • Employee engagement events
  • Employee assistance program
  • Employee recognition program
  • Free parking

Disclaimer: Benefits are subject to change at the discretion of Ridgeview Institute Monroe.

Compensation:

This is a full-time role and the expected compensation range for this role is $25.00 - $28.00 hourly.  We’re eager to engage with all qualified candidates, and consideration will be provided to experience and skill level. Join us as our Utilization Management Coordinator!

Get to know us Outstanding Care, Compassionate People, Unparalleled Service

Welcome to Ridgeview Institute Monroe (RIM), a leading mental health care hospital in Monroe, GA, dedicated to setting the standard for excellence in psychiatric treatment since 2017. Our hospital offers a full continuum of care, including specialized programs for adolescents, adults, and older adults, including a specialized women's program. We are committed to providing evidence-based treatment approaches to assist our patients in achieving their treatment goals.

At Ridgeview Institute Monroe, we believe in the power of community and collaboration. Our team works closely with the community to build an efficient, comprehensive, and seamless continuum of care. We take pride in offering dynamic, challenging, and highly rewarding positions that will positively impact you and those in our care. You'll have the opportunity to work closely with a team of experts, ensuring our patients receive personalized services that guide them towards achieving their treatment goals.

Join us in providing exceptional care and contributing to the well-being of individuals and families in need, and be a part of the transformative healthcare experience at Ridgeview Institute Monroe.

To learn more about Ridgeview Institute Monroe, visit us at: https://ridgeviewinstitute.com/monroe/

TOGETHER WE CAN MAKE POSITIVE I.M.P.A.C.T.S.

Individuals Maintaining Positive Attitude and Commitment To Service

_________________________________________________________________________________

At Ridgeview Institute Monroe, we value a diverse, inclusive workforce and provide equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

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