ZipRecruiter

Log In

2

Full Time Utilization Management Jobs in Detroit, MI

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8:00 am to 4 ...

Spectrum Health

RN Care Coordinator

Trenton, MI

Identifies patients that need care management services (i.e. utilization review; care coordination ... Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8A-430P Days ...

Spectrum Health

RN Care Coordinator

Dearborn, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8:00 am to 4 ...

Corewell Health

RN Care Coordinator

Trenton, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8A-430P Days ...

Park Pharmacy

Clinical Manager - Behavioral Health

Detroit, MI · On-site

$59K - $81K/yr

Is fluent in CPT/HCPCS coding and utilization management, and comfortable in an EHR and Microsoft ... ASAP Job Type: Full Time, Exempt Salaried Schedule: Monday - Friday standard business hours with ...

next page

Showing results 1-20

All JobsUtilization Management JobsFull Time Utilization Management JobsFull Time Utilization Management Jobs in Detroit, MI

Full Time Utilization Management information

See Detroit, MI salary details

$38.6K

$88.6K

$161.4K

How much do full time utilization management jobs pay per year?

As of Sep 8, 2026, the average yearly pay for full time utilization management in Detroit, MI is $88,585.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,900.00 and $103,500.00 per year, depending on experience, location, and employer.

What is utilization management?

Utilization Management (UM) in a full-time role involves evaluating the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Professionals in this field, often nurses or healthcare administrators, review patient cases, coordinate with healthcare providers, and ensure that care meets established guidelines while controlling costs. Their goal is to optimize patient outcomes by ensuring the right level of care is provided at the right time, while also helping organizations comply with regulations and insurance requirements.

How does a full time utilization management role typically interact with clinical and administrative teams?

In a Full Time Utilization Management position, you will regularly collaborate with both clinical staff, such as physicians and nurses, and administrative teams, like case managers and billing specialists. Your main responsibility is to review patient care requests, ensure services are medically necessary, and coordinate approvals or denials based on established guidelines. Effective communication and teamwork are essential, as you’ll often facilitate discussions between departments to optimize patient outcomes and resource use. This collaborative environment helps you build a broad understanding of healthcare processes and strengthens your problem-solving skills.

What are the key skills and qualifications needed to thrive as a full time utilization management professional?

To thrive in Full Time Utilization Management, you need a background in healthcare (often as an RN or other clinical license), strong knowledge of medical necessity criteria, and familiarity with insurance guidelines. Expertise in case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are typically required. Attention to detail, critical thinking, effective communication, and negotiation skills help you advocate for appropriate patient care while managing costs. These skills ensure efficient resource allocation, compliance with regulations, and optimal patient outcomes within healthcare organizations.

What is the difference between Full Time Utilization Management vs Utilization Review Nurse?

AspectFull Time Utilization ManagementUtilization Review Nurse
CredentialsRN license, certifications in case management or utilization reviewRN license, certifications in utilization review or case management
Work EnvironmentTypically full-time, office-based, healthcare organizationsOften part-time or per review, hospital or insurance settings
Employer & IndustryHealth insurance companies, healthcare providersHospitals, insurance companies, third-party review organizations

Full Time Utilization Management professionals oversee the entire utilization review process, often in a full-time capacity, focusing on managing patient care and resource utilization. Utilization Review Nurses perform specific review tasks, usually on a case-by-case basis, and may work part-time or per review. Both roles require RN licensure and related certifications, but Full Time Utilization Management roles involve broader responsibilities and continuous oversight.

What are the most commonly searched types of Utilization Management jobs in Detroit, MI?

The most popular types of Utilization Management jobs in Detroit, MI are:

Full Time Utilization Management jobs near you

RN Utilization Management Coordinator

Spectrum Health

Southfield, MI • Hybrid

Full-time

Medical, Retirement

Posted 10 days ago

Job description

This will be 8 hour days- 5 days a week.

Scope of work
This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.
  • Participates within the department to meet expected objectives and outcomes.
  • Meets or exceeds expectations related to behavior and performance. Meets individual and departmental objectives established for Quality, Satisfaction, Growth and Financial Success.
  • Conducts timely and accurate utilization reviews, as assigned, using organization-approved UR criteria.
  • Works closely with physician advisors and medical staff to ensure appropriate level of care, including obtaining physician orders for patient class changes when needed.
  • Refers cases, as defined, for 2nd level medical necessity review.
  • Maintains daily contact with payers to obtain authorization and reauthorization information and addresses concurrent denials and/or audit requests.
  • Provides UR and clinical documentation is adequate and complies with payer requirements.
  • Schedules next review/follow-up reviews as required in accordance with organizational policy and procedure and payer requests.
  • Routinely collaborates with the System Clinical Appeals and Revenue Cycle departments to expedite billing and appeals processes.
  • Maintains and monitors assigned work queues within the Electronic Medical Record.
Qualifications
  • Required Associate's Degree Associates or technical degree.
  • Preferred Bachelor's Degree in nursing or related field.
  • 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
  • Hospital utilization review/utilization management experience. Preferred
  • Clinical appeals experience. Preferred
  • Registered Nurse (RN) - State of Michigan Upon Hire required

    How Corewell Health cares for you
    • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
    • On-demand pay program powered by Payactiv
    • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
    • Optional identity theft protection, home and auto insurance
    • Traditional and Roth retirement options with service contribution and match savings
    • Eligibility for benefits is determined by employment type and status

    Primary Location

    SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

    Department Name

    Utilization Management - Diversified East WB Mkt

    Employment Type

    Full time

    Shift

    Day (United States of America)

    Weekly Scheduled Hours

    40

    Hours of Work

    40

    Days Worked

    M-F

    Weekend Frequency

    N/A

    CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

    Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

    Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

    An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

    You may request assistance in completing the application process by calling 616.486.7447.

    Apply