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Utilization Reviewer Jobs in Macon, GA (NOW HIRING)

CHSGa

RAI Specialist for Skilled Nursing Services

Gray, GA · On-site

$34.50 - $41.75/hr

... review and communication with skilled nursing center. * Assists with development of Procedural Guidelines related to MDS/RAI, Resource Utilization Groupings and Quality Measures. * Provides ...

CHSGa

RAI Specialist for Skilled Nursing Services

Gray, GA · On-site

$34.50 - $41.75/hr

... review and communication with skilled nursing center. * Assists with development of Procedural Guidelines related to MDS/RAI, Resource Utilization Groupings and Quality Measures. * Provides ...

CHSGa

RAI Specialist for Skilled Nursing Services

Gray, GA · On-site

$34.50 - $41.75/hr

... review and communication with skilled nursing center. * Assists with development of Procedural Guidelines related to MDS/RAI, Resource Utilization Groupings and Quality Measures. * Provides ...

Medcadre Inc

Registered Pharmacist

Gray, GA · On-site

Pharmaceutical care, Medication therapy management, Drug utilization review, Patient counseling, Compounding, Inventory management, Regulatory compliance, Clinical research, Drug interaction ...

MedCadre

Registered Pharmacist

Gray, GA · On-site

Pharmaceutical care, Medication therapy management, Drug utilization review, Patient counseling, Compounding, Inventory management, Regulatory compliance, Clinical research, Drug interaction ...

Gianteagle

Pharmacy Intern

Mcintyre, GA · On-site

$15 - $18.75/hr

Alert pharmacists appropriately for drug utilization reviews, calling and resolving third party rejections and rebilling claims, entering and processing refills and adding patients to Refills on Time ...

Sound Physicians

Medical Director Physician

Macon, GA · On-site

We focus on utilization management (UM), compliance, and clinical documentation improvement (CDI ... Organize and participate in monthly team meetings to review performance, address outstanding ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Macon, GA

Utilization Reviewer information

See Macon, GA salary details

$29.7K

$36.4K

$42.2K

How much do utilization reviewer jobs pay per year?

As of Aug 30, 2026, the average yearly pay for utilization reviewer in Macon, GA is $36,437.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,600.00 and $40,300.00 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 Macon, GA, the most frequently searched job titles are:

What job categories do people searching Utilization Reviewer jobs in Macon, GA look for?

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

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

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

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Macon, GA as of August 2026, with employment types broken down into 66% Full Time, and 34% Part Time. Highlights an 72% In-person, and 28% Remote job distribution, with an average salary of $36,437 per year, or $17.5 per hour.

Utilization Review Nurse

Houston Healthcare

Warner Robins, GA • On-site

Full-time

Posted 4 days ago

Job description

Work Shift:

The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The Utilization Reviewer serves as a resource to medical and hospital staff on utilization and regulatory issues and participates in coordination of individualized patient care services. The Utilization Reviewer plays an integral role in discharge planning and maximizing the continuum of care for patients assigned to his/her assigned unit. The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for the patient.
Qualifications:
Education & Training:
Graduate of an accredited School of Nursing.
Experience:
Three (3) years in an acute care setting.
Required Certification/Registration/Licensure:
Current US state RN license with authorization to practice in the state of GA.
Knowledge, Skills & Abilities:
Utilizes a variety of standard office equipment to include computer, printer, fax machine, copier, telephone etc. Basic knowledge of statistics encouraged.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.

Scheduled Weekly Hours:

40

FTE:

1

Expanded Work Shift:

On Call:

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