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Insurance Review Nurse Jobs in Michigan (NOW HIRING)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full ... Term Life Insurance Plan. * We will consider for employment all qualified Applicants, including ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Term Life Insurance Plan. * We will consider for employment all qualified Applicants, including ...

G-TECH Services

RN-Clinical Review Analyst

Detroit, MI · On-site

$33 - $34/hr

... N license. You will perform prospective, concurrent and retrospective review of inpatient ... One (1) year health insurance plan experience or managed care environment preferred Education ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Insurance and much more! More information is available on our Benefits Guest Website: benefits ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Insurance and much more! More information is available on our Benefits Guest Website: benefits ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Insurance and much more! More information is available on our Benefits Guest Website: benefits ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Manager of Utilization Review

Saint Johns, MI

... insurance and much more. About Universal Health Services One of the nation's largest and most ... C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Requirements LMSW, LPC, RN or LV ...

Posted today

UHS

Manager of Utilization Review

Saint Johns, MI

... insurance and much more. About Universal Health Services One of the nation's largest and most ... C., Puerto Rico and the United Kingdom. www.uhs.com Qualifications Requirements LMSW, LPC, RN or LV ...

Posted today

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All JobsInsurance Review Nurse JobsInsurance Review Nurse Jobs in Michigan

Insurance Review Nurse information

See Michigan salary details

$17.3K

$44.1K

$69.5K

How much do insurance review nurse jobs pay per year?

As of Aug 19, 2026, the average yearly pay for insurance review nurse in Michigan is $44,108.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,700.00 and $51,800.00 per year, depending on experience, location, and employer.

What is an insurance review nurse?

Insurance Review Nurses are registered nurses who evaluate medical records and treatment plans to determine if healthcare services are medically necessary and covered by insurance policies. They act as a liaison between healthcare providers, patients, and insurance companies to ensure that claims meet policy guidelines. Their work helps prevent unnecessary treatments and controls healthcare costs while ensuring patients receive appropriate care.

What skills and qualifications are needed to be an insurance review nurse?

To thrive as an Insurance Review Nurse, you need a registered nursing license, strong clinical knowledge, and experience in case management or utilization review. Familiarity with medical coding systems (such as ICD-10 and CPT), healthcare regulations, and insurance software platforms is typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating medical records and collaborating with providers. These skills ensure accurate, efficient reviews that support appropriate coverage decisions and compliance with regulatory standards.

What challenges do insurance review nurses face when evaluating medical necessity for insurance claims?

Insurance Review Nurses often encounter challenges such as interpreting complex medical records, staying current with evolving insurance policies and clinical guidelines, and balancing the interests of patients, providers, and insurers. They must exercise critical thinking to make impartial decisions while navigating tight deadlines and high caseloads. Collaborating effectively with physicians, case managers, and claims adjusters is crucial to ensure accurate and fair assessments.

What is the difference between Insurance Review Nurse vs Claims Nurse?

AspectInsurance Review NurseClaims Nurse
CredentialsRN license, possibly certifications in case management or insuranceRN license, certifications in case management or insurance
Work EnvironmentReviewing insurance claims, assessing coverage, working with insurance companiesHandling patient claims, coordinating with insurance providers, clinical assessments
Employer & IndustryInsurance companies, third-party administratorsHospitals, insurance companies, healthcare providers

Both roles require RN licensure and similar certifications, often working within insurance or healthcare settings. Insurance Review Nurses primarily evaluate insurance claims for coverage and compliance, while Claims Nurses handle patient claims, ensuring proper processing and coordination. Although their tasks differ, both roles focus on insurance and healthcare integration, making them closely related in the industry.

What are popular job titles related to Insurance Review Nurse jobs in Michigan?

For Insurance Review Nurse jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Insurance Review Nurse jobs in Michigan look for?

The top searched job categories for Insurance Review Nurse jobs in Michigan are:

Insurance Review Nurse jobs near you
Infographic showing various Insurance Review Nurse job openings in Michigan as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $44,108 per year, or $21.2 per hour.

Utilization Review Nurse

Medix

Southfield, MI • On-site

$42 - $46/hr

Full-time

Medical, Dental, Vision, Retirement

Posted 27 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a Utilization Review Nurse. This role involves managing the full lifecycle of Independent Review Organization (IRO) cases, ensuring compliance with regulatory deadlines and maintaining accurate case tracking. The position requires collaboration with various stakeholders to support case progression and process optimization.
Key Responsibilities
  • Manage the full lifecycle of IRO cases from intake through final case closure.
  • Review incoming clinical documentation, verify completeness, and prepare concise case summaries for physician reviewers.
  • Coordinate and route cases to the appropriate physician specialty while managing requests for additional medical records.
  • Perform quality assurance (QA) on physician reports to ensure accuracy, clarity, completeness, and defensibility.
  • Monitor regulatory deadlines, case status, and documentation to ensure timely, compliant case completion.
  • Maintain accurate case tracking and documentation within internal systems and state IRO programs.
  • Collaborate with physicians, clients, and internal teams to resolve documentation gaps and support case progression.
  • Contribute to workflow improvements, new state program implementation, and process optimization as the organization grows.

Qualifications
  • Active RN license and BSN required.
  • Experience with Independent Review Organizations (IROs), or Utilization Review/Appeals within a Health Plan or TPA.
  • Strong clinical documentation review, case summary writing, and quality assurance (QA) skills.
  • Excellent written communication with exceptional attention to detail and ability to identify gaps in physician documentation.
  • Ability to independently manage multiple cases while meeting regulatory turnaround times and deadlines.

Skills
  • Technical skills: Experience with IROs, clinical documentation review, case summary writing, quality assurance.
  • Soft skills: Excellent written communication, attention to detail, ability to manage multiple cases effectively.

Additional Requirements
M-F 8-5 schedule preferred CST/MST time zones for training; flexible with time zones. Some weekend coverage may be needed occasionally. Open to overtime if required and candidates are willing.
Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
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About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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