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Insurance Utilization Review Jobs in Michigan (NOW HIRING)

G-TECH Services

RN-Clinical Review Analyst

Detroit, MI · On-site

$33 - $34/hr

... 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 ...

Corewell Health

RN Care Coordinator

Grosse Pointe, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator

Royal Oak, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator

Royal Oak, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Spectrum Health

RN Care Coordinator

Grosse Pointe, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator

Grosse Pointe, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator Rehab inpatient

Taylor, MI · On-site

$34.50 - $41.75/hr

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator Rehab inpatient

Taylor, MI · On-site

$34.50 - $41.75/hr

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Spectrum Health

RN Care Coordinator

Royal Oak, MI

... utilization review; care coordination; and/or discharge/transition planning). 2. Responsible for ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Spectrum Health

RN Care Coordinator

Royal Oak, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

Corewell Health

RN Care Coordinator

Royal Oak, MI · On-site

... utilization review; care coordination; and/or discharge/transition planning). 2. Responsible for ... Optional identity theft protection, home and auto insurance * Traditional and Roth retirement ...

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Insurance Utilization Review information

See Michigan salary details

$18

$36

$60

How much do insurance utilization review jobs pay per hour?

As of Jul 14, 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 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.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

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 is an Insurance Utilization Review job?

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 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 July 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. 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.
Utilization Management Clinical Analyst - SUD HYBRID (PCN 1543)

Utilization Management Clinical Analyst - SUD HYBRID (PCN 1543)

Oakland Community Health Network

Troy, MI • On-site

$56K - $70K/yr

Full-time

Posted 12 days ago

Job description

Job Summary

The Utilization Management Clinical Analyst – Substance Use Disorder (SUD) conducts prospective and concurrent reviews of substance use disorder authorization requests to determine medical necessity and clinical appropriateness of behavioral health services in accordance with American Society of Addiction Medicine (ASAM) Level Need, Medicaid guidelines, MDHHS requirements, and the Michigan Mental Health Code. This position applies clinical expertise and evidence-based criteria to support timely utilization management decisions, promote appropriate resource utilization, and ensures quality, individualized treatment through collaboration with providers and internal stakeholders. The scope of this position includes the review of clinical care and treatment plans for the SUD provider network.


Essential Functions

    • Apply advanced clinical expertise, best practices, medical necessity criteria, Medicaid and PIHP requirements, regulatory standards, and organizational policies to determine the clinical appropriateness of SUD authorization requests.
    • Independently perform comprehensive medical necessity reviews of prospective and concurrent service authorization requests by analyzing complex clinical information, assessments, treatment plans, and supporting documentation to determine the appropriate amount, scope, duration, intensity, and ASAM level of care needed to meet assessed needs, ensuring decisions are clinically sound, timely, well-documented, and consistent with individualized treatment planning principles and applicable benefit requirements.
    • Ensure authorization decisions comply with applicable federal and state regulations, Medicaid Provider Manual requirements, ASAM guidelines, PIHP contractual obligations, evidence-based clinical guidelines, and organizational policies and procedures.
    • Analyzes records to determine legitimacy of admission, treatment, and length of stay in residential settings to comply with government and insurance company reimbursement policies analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning treatment and length of stay.
    • Review requests for transitions between ASAM levels of care and facilitate referral to the next SUD provider.
    • Determines continued stay review dates according to established clinical protocols and diagnostic criteria.
    • Complete retrospective utilization reviews to evaluate whether services provided were medically necessary, clinically appropriate, adequately documented, and delivered in the appropriate amount, scope, duration, and intensity to achieve the goals identified in the treatment plan.
    • Participate in the development, validation, implementation, and continuous improvement of utilization management policies, clinical protocols, decision-support tools, audit processes, and workflow enhancements.
    • Collaborate with internal clinical teams, provider organizations, and community partners to facilitate effective care coordination, timely communication, discharge planning, and continuity of care.
    • Participate in interdisciplinary committees, quality improvement initiatives, utilization management workgroups, and external stakeholders to support system-wide clinical quality and compliance.
    • Monitor and analyze utilization patterns, service trends, and authorization data to identify opportunities for quality improvement, ensure appropriate utilization, support regulatory compliance, and inform utilization management practices.
    • Maintain current knowledge of behavioral health standards of care and state and federal policy and regulations.
    • Perform other duties and special projects as assigned.



Job Requirements and Qualifications

Education:

  • Master’s degree in the mental health field or a relevant discipline required.

Training Requirements (licenses, programs, or certificates):

    • Possession and maintenance of a current, unrestricted State of Michigan professional license in one of the following disciplines:
      • Licensed Psychologist (LLP or LP)
      • Licensed Master's Social Worker (LMSW)
      • Licensed Professional Counselor (LPC)
      • Licensed Marriage and Family Therapist (LMFT)
      • Registered Nurse (RN)
    • CADC, CAADC, or development plan for the CADC/CAADC credentials.

Experience Requirements:

  • Minimum of five (5) years relevant experience providing services to Adults with Substance Use Disorder.
  • Preference for knowledge of the PIHP responsibilities for utilization management related to substance use disorder services.

Preferred Experience

  • Experience within a Community Mental Health Services Program (CMHSP), Prepaid Inpatient Health Plan (PIHP), Managed Care Organization (MCO), hospital, or behavioral health setting.

Knowledge Requirements

  • Michigan Mental Health Code.
  • Medicaid guidelines, regulations, and Michigan Medicaid Provider Manual.
  • Manage Care Principles and Utilization Management.
  • Demonstrated understanding of the application and outcome measurement of Substance Use Disorder Practices.
  • Knowledge of American Society of Addictions Medications (ASAM) Criteria.
  • Knowledge of substance use disorders and DSM-5.
  • Working knowledge of HIPPA and 42-CFR rules and compliance.

Job Specific Competencies/Skills:

  • Ability to work effectively in a team environment.

  • High level of understanding of various treatment processes.

  • Effective communication skills (written, oral and computer)

  • Ability to apply knowledge and evidence-based practices to complex decision-making situations.


Oakland Community Health Network’s Core Competencies:

  • Interacting with others in a way that gives them confidence in one’s intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
  • Making customers and their needs a primary focus of one’s actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
  • Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning)
  • Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
  • Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Other Information

(Travel required, physical requirements, and so on):

  • Must have available means of transportation to and from OCHN and for required offsite meetings or site visits.
  • Must be available for meetings and events which may occur outside of standard office hours.
  • Work performed primarily in an office environment.
  • Hybrid (onsite/remote) work schedule available.
  • The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.