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Utilization Reviewer Jobs in Atlanta, GA (NOW HIRING)

Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Wellstar Health System

UM Manager-Onsite

Vinnings, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Mableton, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Smyrna, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Austell, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Roswell, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Marietta, GA · On-site

Resource for Utilization Review within continuum of care.* Sustain professional competency; pursue clinical skill development and specialty certification.* Facilitate case management across the ...

Wellstar Health System

UM Manager-Onsite

Woodstock, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

Wellstar Health System

UM Manager-Onsite

Kennesaw, GA · On-site

Resource for Utilization Review within continuum of care. * Sustain professional competency; pursue clinical skill development and specialty certification. * Facilitate case management across the ...

New

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Showing results 21-40

All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Atlanta, GA

Utilization Reviewer information

See Atlanta, GA salary details

$29.8K

$36.5K

$42.3K

How much do utilization reviewer jobs pay per year?

As of Sep 4, 2026, the average yearly pay for utilization reviewer in Atlanta, GA is $36,535.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,700.00 and $40,400.00 per year, depending on experience, location, and employer.

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.

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 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 do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
More about Utilization Reviewer jobs

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For Utilization Reviewer jobs in Atlanta, GA, the most frequently searched job titles are:

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The top searched job categories for Utilization Reviewer jobs in Atlanta, GA are:

What cities near Atlanta, GA are hiring for Utilization Reviewer jobs?

Cities near Atlanta, GA with the most Utilization Reviewer job openings:

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Atlanta, GA as of August 2026, with employment types broken down into 2% As Needed, 80% Full Time, 10% Part Time, and 8% Contract. Highlights an 80% In-person, 2% Hybrid, and 18% Remote job distribution, with an average salary of $36,535 per year, or $17.6 per hour.

Utilization Specialist

Acadia Healthcare

Riverdale, GA

Full-time

Re-posted 17 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

697th of 898 rated healthcare providers

Job description

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  


ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances

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About Acadia Healthcare

Sourced by ZipRecruiter

Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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