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Manager Utilization Management Jobs in Michigan (NOW HIRING)

Lthc

Utilization Management Services Rep I

Dewitt, MI · On-site

$13.50 - $18.25/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Lthc

Utilization Management Services Rep I

Dewitt, MI · On-site

$13.50 - $18.25/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Ambition 24Hours Inc

Director Case Management

Detroit, MI · On-site

$103K - $155K/yr

Lead utilization management and medical necessity review processes * Ensure compliance with CMS regulations and Joint Commission standards * Manage patient transition planning and discharge ...

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Manager Utilization Management information

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 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 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 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 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 July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution.

Utilization Review Manager

Acadia Healthcare

New Baltimore, MI • On-site

$25 - $35/hr

Full-time

Re-posted 22 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 190 frontline employees who took The Breakroom Quiz

699th of 887 rated healthcare providers

Job description

Overview
Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team!
Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI.
Non-Exempt Position
Full Time Position
Monday - Friday - Day Shift
Rate of Pay: $25.00 - $35.00 per hour (based on experience)
Responsibilities
PURPOSE STATEMENT:
Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.
ESSENTIAL FUNCTIONS:
  • Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
  • Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
  • Evaluate the utilization program for compliance with regulations, policies and procedures.
  • Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
  • Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:
  • Perform other functions and tasks as assigned.

Qualifications
LICENSES/DESIGNATIONS/CERTIFICATIONS:
  • If applicable, current licensure as an LPN or RN or LPC, or LMSW or LLMSW within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
  • First aid may be required based on state or facility requirements.

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About Acadia Healthcare

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Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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