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Insurance Utilization Review Jobs in Michigan (NOW HIRING)

ICONMA

Registered Nurse-Review Analys

Detroit, MI · On-site

Registered Nurse-Review Analyst Our client, a Health Insurance company, is looking for a Registered ... insurance plan experience or managed care environment preferred. One (1) year of utilization ...

OpTech LLC

RN Utilization Management

Detroit, MI · On-site

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ... Technical - MS Office, Type 35+ WPM, Dual monitors, multiple systems * 1 yr health insurance plan ...

OpTech

RN Utilization Management

Detroit, MI · On-site

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ... Technical - MS Office, Type 35+ WPM, Dual monitors, multiple systems * 1 yr health insurance plan ...

Corewell Health

RN Care Coordinator

Farmington Hills, 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 options ...

Spectrum 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

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 ...

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

Dearborn, 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 ...

Corewell 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 ...

Corewell Health

RN Care Coordinator

Farmington, 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

Dearborn, 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

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 ...

Corewell Health

RN Care Coordinator

Dearborn, 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

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

Dearborn, 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

Dearborn, 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 ...

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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.

Medical Review Specialist- REMOTE (EST zone)

MEDLOGIX, LLC

Southfield, MI • On-site

$23 - $27/hr

Full-time

Re-posted 8 days ago

Key responsibilities

  • Review medical bills and documentation to determine if treatment is related and necessary to the covered injury.

  • Provide reimbursement recommendations based on review guidelines and policies.

  • Assist customers such as adjusters, providers, and claimants with bill review inquiries and provide quality customer service.

Job description

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

ReviewWorks, a Medlogix company founded in 1989 located in Northville, Michigan. Provides comprehensive Medical Review Services, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, third party administrators and insurance carriers.


TITLE: 

Medical Review Specialist

TYPE:

Full time – (40 hours per week)

Non-Exempt

Remote- EST time zone


POSITION SUMMARY:

The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations for Michigan Workers' Compensation claims. The incumbent is also responsible for the quality timeliness and customer service for assigned accounts.


ESSENTIAL FUNCTIONS:

  • Reviews medical bills and documentation according to guidelines and RW policies and procedures.
  • Determines if treatment is related and necessary to the covered injury.
  • Advises reimbursement recommendations are appropriate.
  • Provides customer service to adjusters, providers, and claimants regarding bill review. 
  • Assesses appropriateness and duration of care provided, for possible utilization review.
  • Recommends independent medical evaluations (IME) to adjusters when necessary.
  • Act as a resource to other staff members to facilitate completion of a quality product. 
  • Use appropriate reference material as necessary to perform professional review.
  • Meets company productivity standards. 
  • Meets company quality standards.


Professional Background:


Certified Professional Coder – required

1+ years medical coding experience – CPT, ICD-10 - preferred

1+ years’ experience in Medical Bill Repricing – preferred

Michigan Workers' Compensation experience- preferred

 

SKILLS AND ABILITIES:


Ability to apply clinical knowledge and/or coding expertise in bill review

Ability to read, write, speak, and understand English well

Ability to understand and follow written and oral instructions

Possess strong verbal and interpersonal skills

Ability to multi-task 

Possess problems solving skills

Ability to sit for long periods at a computer terminal keyboarding

PC skills – required 

Knowledge of Microsoft Office Products – required 

Ability to operate standard office equipment including telephone

 

PERSONAL CHARACTERISTICS:

Initiative, drive, creativity and persistence

Good organizational skills

Highest professional ethics

Ability to work independently



EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.