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Medical Director Utilization Management Jobs in Michigan

Integra Partners

Director of Utilization Management

Troy, MI · On-site +1

$160K - $160K/yr

Integra's Utilization Management (UM) division is looking for an experienced individual to direct ... Work with Chief Medical Director to establish, adopt, and review UM benefit and medical necessity ...

Spectrum Health

Utilization Mgmt Spec

Southfield, MI · On-site

Utilizes electronic medical record work queues that support Utilization Management functions. * Answers incoming calls or places outbound calls with appropriate communication skills. Triages all ...

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Medical Director Utilization Management information

See Michigan salary details

$11.3K

$202.5K

$311.2K

How much do medical director utilization management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for medical director utilization management in Michigan is $202,531.00, according to ZipRecruiter salary data. Most workers in this role earn between $172,600.00 and $248,000.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

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

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

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

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

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

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

What cities in Michigan are hiring for Medical Director Utilization Management jobs?

Cities in Michigan with the most Medical Director Utilization Management job openings:

Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in Michigan as of August 2026, with employment types broken down into 100% Full Time. Highlights an 73% In-person, and 27% Remote job distribution, with an average salary of $202,531 per year, or $97.4 per hour.

Director of Utilization Management

Integra Partners

Troy, MI • On-site, Remote

$160K - $160K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

Job description

Integra's Utilization Management (UM) division is looking for an experienced individual to direct the clinical and non-clinical utilization management teams for a managed care organization. This individual will play a key role in delivering UM to our health plan clients, growing our UM business, and working with the organization to operationalize our UM program.
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The Director of Utilization Management's responsibilities include but are not limited to:
  • Prepare and maintain Utilization Review Plan policies and procedures
  • Obtain or maintain certification or license in states when performing Utilization Review
  • Work with Chief Medical Director to establish, adopt, and review UM benefit and medical necessity decision-making criteria
  • Manage UM Department, clinical and non-clinical staff, to ensure timely review of prior authorizations and appeals
  • Responsible for UM-related quality improvement activities, including conducting audits to ensure consistent application of medical criteria, evaluating program for improvement opportunities and annual IRR testing
  • Communicate and work with company executives and management to ensure alignment of UM program with departments and corporate initiatives
  • Participate on Quality Improvement Committee and UM Committee to oversee clinical oversight of UM Department
  • Work in conjunction with Account Managers and external liaison for clients to ensure program meets contractual delegated activities and performance requirements
  • As needed, represent the UM team in support of client-facing efforts such as business development and/or business review activities.
  • Help consult on existing and/or prospective client UM programs
  • Participate in technology related activities and implement solutions across UM Department
  • Oversee and execute the workplan to maintain NCQA certification
  • Build and manage the administrative and clinical resources to ensure the UR program functions efficiently and effectively, meeting all internal, legal, regulatory, and/or certification standards
  • Build and maintain a staffing model that is flexible and appropriate to scale as the business scales
  • Manage internal policies and procedures and workflows to ensure compliance, effectiveness, and best in class clinical operations
  • Owner of the third party technology and configuration of medical management software to ensure optimal operation
  • Responsible for day-to-day team management to ensure on-time, on-budget delivery of all operations • As needed, represent the UM team in support of client-facing efforts such as business development and/or business review activities
  • Help consult on existing and/or prospective client UM programs

WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
  • In the first six months you will learn the function of the UM department within the organization and be fully integrated in your position, company, and team
  • You will have a full and complete understanding of our metric requirements and reporting capabilities
  • You will understand your role and responsibilities, to foster excellence in team performance
  • You will develop team goals and monitor progress, as you build relationships with your team to encourage and understand their needs and abilities
  • During this time, you will set measurable goals for personal development and growth

WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
  • You will create a people first approach to your team, easily identifying the strengths and weakness of each team member and how to best support them
  • You will be contributing your skills and knowledge to meet your department's metrics and goals

EXPERIENCE:
  • Bachelor's degree in area of specialty, preferred
  • Minimum of 10 years of UM management experience in a managed care setting
  • Experience with UM NCQA or URAC certification/accreditation
  • Experience with leading and managing teams of clinical and non-clinical staff
  • Analytical ability and clinical knowledge in order to assess medical records, identify trends, and report findings
  • Communication skills, verbal and written, needed to convey information clearly and consistently
  • Interpersonal skills necessary to develop and maintain a wide variety of cooperative working relationships

Salary: $160,000.00/Annually
Benefits Offered
  • Competitive compensation and annual bonus program
  • 401(k) retirement program with company match
  • Company-paid life insurance
  • Company-paid short term disability coverage (location restrictions may apply)
  • Medical, Vision, and Dental benefits
  • Paid Time Off (PTO)
  • Paid Parental Leave
  • Sick Time
  • Paid company holidays and floating holidays
  • Quarterly company-sponsored events
  • Health and wellness programs
  • Career development opportunities

Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We're looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don't hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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