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Manager Utilization Management Jobs in Michigan (NOW HIRING)

Corewell Health

Utilization Mgmt Spec

Southfield, MI · On-site

Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...

Spectrum Health

Utilization Mgmt Spec

Southfield, MI · On-site

Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...

OpTech LLC

RN Utilization Management

Detroit, MI · On-site

Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan. Perform prospective, concurrent and retrospective review ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... This includes the implementation of case management scenarios, consulting with all services to ...

UHS

Utilization Review Manager

Grand Rapids, MI

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... This includes the implementation of case management scenarios, consulting with all services to ...

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Manager Utilization Management information

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

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

The most popular types of Utilization Management jobs in Michigan are:

What are popular job titles related to Manager Utilization Management jobs in Michigan?

For Manager Utilization Management jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Michigan look for?

The top searched job categories for Manager Utilization Management jobs in Michigan are:

What cities in Michigan are hiring for Manager Utilization Management jobs?

Cities in Michigan with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Michigan as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution.

Utilization Management Coordinator

West Michigan Community Mental Health System

Ludington, MI • On-site

Full-time

Re-posted 24 days ago

Job description

The Utilization Management Coordinator is responsible for performing retrospective monitoring and audit functions relative to WMCMH utilization management processes/systems. The Utilization Management Coordinator will monitor and audit the effectiveness of the WMCMH Utilization Management processes/systems, provide data to support organizational utilization decision-making, facilitate the WMCMH Utilization Management Committee and be an active participant in the Lakeshore Regional Entity UM ROAT and other regional and state UM workgroups/committees as appropriate. The Utilization Management Coordinator will be housed on the Operations Team and will work very closely with other members of the organization.

JOB DUTIES: Utilization Management - Through retrospective review and use of both strong QI principles and strong data aggregation and analysis skills, the Utilization Management Coordinator will: Perform monitoring and audit functions (objective examination) relative to utilization management and/or effectiveness of WM utilization management (i.e., size and composition and accessibility of WM network; appropriateness of authorization bundles; compliance with WM authorization decision guidelines; ensure presence of golden thread; ensure consistent and compliant authorization decisions and supporting documentation, etc.). In response to monitoring and audit functions, facilitate the development and monitoring of performance improvement plans as appropriate. Provide/Aggregate data to support the need for new programs and/or discontinuing programs that are ineffective or inefficient

Provide/Aggregate data to support the need for incorporating new or discontinuing the use of evidence-based practices. Provide/Aggregate data to support maintenance/updates to authorization decision guidelines. Facilitate the WMCMH Utilization Management Committee Participate in the Lakeshore Regional Entity UM ROAT and other state/regional UM workgroups as appropriate.

Back-Up Coverage - Provide limited, short-term/backup coverage for other Operations or organizational Coordinators as needed.

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