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Insurance Utilization Review Jobs in Michigan (NOW HIRING)

Corewell Health

RN Care Coordinator

Troy, 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

Trenton, 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 ...

MyMichigan Health

Mental Health Therapist

Alma, MI · On-site

May need to fill in for utilization review as needed. (10%)* Maintains program patient medical ... Verifies Patients' insurance, obtains authorization to bill for treatment, and ensures program ...

Lancesoft INC

RN- Case Manager

Pontiac, MI · On-site

$2.1K - $2.2K/wk

... starting Utilization Review - Preferred Insurance Authorization experience - Preferred CCM - Preferred Company Description LanceSoft is rated as one of the largest staffing firms in the US by SIA.

Lancesoft INC

RN Case Manager

Pontiac, MI · On-site

$2.1K - $2.2K/wk

... starting Utilization Review - Preferred Insurance Authorization experience - Preferred CCM - Preferred Company Description LanceSoft is rated as one of the largest staffing firms in the US by SIA.

Trinity Health

Case Management

Livonia, MI · On-site

Full benefits package including Medical, Dental, Vision, PTO, Life Insurance, Short and Long-term ... in utilization review/management/discharge planning or case management. • Current knowledge of ...

Trinity Health

Case Manager

Livonia, MI

$18.75 - $24/hr

Full benefits package including Medical, Dental, Vision, PTO, Life Insurance, Short and Long-term ... Knowledge of federal, state and local regulation affecting utilization review programs and payments.

Trinityhealth

Case Manager

Livonia, MI

$18.75 - $24/hr

Full benefits package including Medical, Dental, Vision, PTO, Life Insurance, Short and Long-term ... Knowledge of federal, state and local regulation affecting utilization review programs and payments.

Trinity Health

Case Manager

Livonia, MI · On-site

$18.75 - $24/hr

Full benefits package including Medical, Dental, Vision, PTO, Life Insurance, Short and Long-term ... in utilization review/management/discharge planning or case management. • Current knowledge of ...

UHS

UM, Case Manager

Auburn Hills, MI · On-site

The Utilization Management Case Manager has a responsibility for organizing and conducting the ... Through clinical skills (experience and knowledge), reports to external insurance and review ...

UHS

UM, Case Manager

Auburn Hills, MI · On-site

The Utilization Management Case Manager has a responsibility for organizing and conducting the ... Through clinical skills (experience and knowledge), reports to external insurance and review ...

UHS

UM, Case Manager

Auburn Hills, MI · On-site

The Utilization Management Case Manager has a responsibility for organizing and conducting the ... Through clinical skills (experience and knowledge), reports to external insurance and review ...

McLaren

Denials Management Assistant

Grand Blanc, MI · On-site

Two years of case management or utilization review, billing, or coding experience • Three years of recent experience doing third party payer certification * Basic Life Support (BLS) certification ...

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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 Aug 18, 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, 70% Full Time, 21% Part Time, 2% Temporary, 5% Contract, and 1% Nights. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

RN Care Coordinator

Corewell Health

Troy, MI • On-site

Other

Medical, Retirement

Posted 4 days ago

Corewell Health rating

7.0

Company rating: 7.0 out of 10

Based on 775 frontline employees who took The Breakroom Quiz

414th of 888 rated healthcare providers

Job description

Scope of work
Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.
  • Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).
  • Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs.
  • Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.
  • May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff.
  • Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.
  • Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations.
  • Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately.
  • Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.
Qualifications
  • Required Bachelor's Degree Graduate of an accredited school of nursing.
  • Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire.
  • 2 years of relevant experience Minimum two years' experience in the acute care setting. Required
  • 3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred
  • Registered Nurse (RN) - State of Michigan Upon Hire required
  • Basic Life Support (BLS) - AHA American Heart Association preferred Or
  • Basic Life Support (BLS) - ARC American Red Cross preferred
  • Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred
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 - Troy Hospital - 44201 Dequindre Rd - Troy
Department Name
Care Management - Troy Hosp
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 4:30 p.m.
Days Worked
Monday to Friday
Weekend Frequency
Every fourth weekend
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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