Southfield, MI · On-site
$48K - $55K/yr
The result is lower expenses and increased productivity for the auto insurance and workers ... Assesses appropriateness and duration of care provided, for possible utilization review.
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Southfield, MI · On-site
$48K - $55K/yr
The result is lower expenses and increased productivity for the auto insurance and workers ... Assesses appropriateness and duration of care provided, for possible utilization review.
Wayne, 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 ...
Wayne, 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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
$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 ...
$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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Implements performance improvement activities to insure consistency and safety within departmental ... Utilization Management • Implements and monitors processes to ensure medical necessity review ...
Implements performance improvement activities to insure consistency and safety within departmental ... Utilization Management • Implements and monitors processes to ensure medical necessity review ...
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.
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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.
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.
Quick apply
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.
Livonia, MI · On-site
$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.
Livonia, MI · On-site
$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.
$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.
$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.
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
$21.18 - $25.46
2% of jobs
$25.46 - $29.75
9% of jobs
$32.68 is the 25th percentile. Wages below this are outliers.
$29.75 - $34.03
21% of jobs
The median wage is $37.50 / hr.
$34.03 - $38.31
23% of jobs
$38.31 - $42.60
13% of jobs
$45.93 is the 75th percentile. Wages above this are outliers.
$42.60 - $46.88
10% of jobs
$46.88 - $51.16
8% of jobs
$51.16 - $55.45
5% of jobs
$55.45 - $59.73
5% of jobs
$59.73 - $64.01
2% of jobs
$64.01 - $68.30
2% of jobs
$21
$41
$68
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.
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.
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.
$48K - $55K/yr
Full-time
Re-posted 8 days ago
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:
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.
Sourced by ZipRecruiter
Insurance services
201 - 500 Employees
Trenton, NJ, US
1980
