Full-Time
Utilization Management Nurse
Health One Alliance
11-50 employees
Georgia health insurance carrier and PSHCC
No salary listed
Dalton, GA, USA
In Person
Daytime or overnight travel may be required.
 Medical, Clinical & Veterinary |
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- Three years of clinical experience is preferred.
- One to two years of utilization review experience is preferred.
- Proficiency in Microsoft Office, including Outlook, Word, and Excel.
- Working knowledge of the National Committee for Quality Assurance is preferred.
- Ability to work independently and creatively.
- Ability to manage multiple projects and priorities.
- Ability to interpret benefits, contract language, medical policy, and medical review criteria.
- A current, active compact-state registered nursing license is required.
- Ability to drive a vehicle and travel during daytime or overnight hours as required.
- Successful completion of a required drug screen and background check.
- Initiate referrals to ensure appropriate coordination of care.
- Seek advice from the Medical Director when appropriate and in accordance with policy.
- Assist non-clinical staff with administrative reviews.
- Perform comprehensive provider and member appeals, interpret denials for letters, conduct retrospective claim reviews and special review requests, and complete utilization management pre-certifications and appeals using medical-appropriateness criteria, clinical judgment, and contractual eligibility.
- Maintain regular and predictable attendance.
- Comply with HIPAA regulations, professional conduct standards, and ethical practice requirements.
- Three years of clinical experience.
- One to two years of utilization review experience.
- Working knowledge of the National Committee for Quality Assurance.
Alliant Health Plans offers health insurance products in Georgia, including fully insured individual, family, and group plans. It provides on- and off-marketplace options and is a Provider Sponsored Health Care Corporation (PSHCC), founded by community physicians and hospitals. How it works: it partners with providers to create a network, offering plans that members use to access care; members enroll in plans that cover medical services from a network of doctors and facilities. How it stands out: its PSHCC model ties care delivery directly to providers, and it has deep local roots with over 20 years of Georgia presence, aiming to improve access to quality health care for members. Company goal: to improve access to quality, affordable health care for Georgia individuals, families, and businesses through provider-aligned insurance products.
Company Size
11-50
Company Stage
N/A
Total Funding
N/A
Headquarters
Dalton, Georgia
Founded
1998
Get referred to Health One Alliance
See people who can refer or advise you
Simplify's Take
What believers are saying
- Alliant kept 2026 product availability across 92 Georgia counties despite higher costs.
- New 2026 Vitruvian plans target Catoosa, Gordon, Murray, and Whitfield counties.
- Provider and member portals improved, reducing servicing friction during open enrollment.
What critics are saying
- Georgia fined Alliant $926,000 on January 19, 2026 for 926 parity violations.
- 2026 premiums jumped 16.4% to 25.4%, pressuring affordability and enrollment.
- Network breadth outside Georgia remains thin, leaving Alliant vulnerable to regional carrier expansion.
What makes Health One Alliance unique
- Health One Alliance owns Georgia's only PSHCC, tightly aligning physicians and hospitals.
- Alliant expanded 2026 individual coverage to 92 Georgia counties and 11 Tennessee counties.
- Local network positioning differentiates Alliant from national carriers in rural Georgia markets.
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Benefits
401(k) Company Match
Health Insurance
Medical Insurance
Dental Insurance
Vision Insurance
Life & AD&D Insurance
Short Term Disability
Long Term Disability
Accident Insurance
Critical Illness Insurance
Employee Assistance Program
Flexible Spending Account
Health Savings Account/Flexible Spending Account
Health & Wellness Program
Paid Time Off
Pet Insurance
Company News
For that reason, Alliant has partnered with Focus Care and their experienced team of licensed health care professionals to support the health of its members by providing a complimentary, no-cost in-home or secure video health evaluation.
As part of its ongoing efforts to support colorectal cancer screening, Alliant Health Plans has partnered with Exact Sciences to provide Cologuard(R) test kits to eligible members who have a recommendation from the Exact Science clinical team.
Ca4wellbeing has, however, partnered with Alliant Health (who do offer plans in its area), and Ca4wellbeing will be in-network providers with Alliant Health/ Health One so that Ca4wellbeing may continue to offer options for its clients who have had plans with Friday Health.