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Insurance Utilization Review Jobs in Michigan (NOW HIRING)

Spectrum Health

Utilization Mgmt Spec

Southfield, MI · On-site

Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization ...

Corewell Health

Utilization Mgmt Spec

Southfield, MI · On-site

Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization ...

Corewell Health

Utilization Mgmt Spec

Southfield, MI · On-site

Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization ...

EPITEC

Registered Nurse-Review Analys

Detroit, MI · On-site

$36 - $39/hr

Position Summary Responsible for performing prospective, concurrent, and retrospective utilization ... experience in a health insurance plan or managed care environment * Clinical experience in:

Epitec

Registered Nurse-Review Analys

Detroit, MI · On-site

$36 - $39/hr

Position Summary Responsible for performing prospective, concurrent, and retrospective utilization ... experience in a health insurance plan or managed care environment * Clinical experience in:

Kyyba

RN Review Analyst

Detroit, MI · On-site

... utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Michigan

Insurance Utilization Review information

See Michigan salary details

$18

$36

$60

How much do insurance utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for insurance utilization review in Michigan is $36.85, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $42.31 per hour, depending on experience, location, and employer.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Michigan?

The most popular types of Insurance Utilization Review jobs in Michigan are:

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

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

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

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

What cities in Michigan are hiring for Insurance Utilization Review jobs?

Cities in Michigan with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 21% Part Time, 5% Contract, and 1% Nights. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

RN Utilization Management Coordinator

Spectrum Health

Southfield, MI • Hybrid

Part-time

Medical, Retirement

Posted 9 days ago

Job description

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 - 25800 Northwestern Highway - Southfield

    Department Name

    Utilization Management - Diversified East WB Mkt

    Employment Type

    Part time

    Shift

    Day (United States of America)

    Weekly Scheduled Hours

    0.04

    Hours of Work

    8

    Days Worked

    Monday - Friday

    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.

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