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Medical Utilization Review Jobs in Michigan (NOW HIRING)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full ... Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities Benefit Highlights: • Excellent Medical, Dental, Vision and Prescription Drug ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

UHS

Utilization Review Manager

Grand Rapids, MI

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities Benefit Highlights: · Excellent Medical, Dental, Vision and Prescription Drug ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

UHS

Utilization Review Manager

Grand Rapids, MI

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsibilities Benefit Highlights: · Excellent Medical, Dental, Vision and Prescription Drug ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

TH Medical

Group Director - Utilization Review

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical, dental, vision, and life insurance 401(k) retirement savings plan with employer match ... The Group Director, Utilization Review will perform the functions necessary to support and advance ...

TH Medical

Group Director - Utilization Review

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical, dental, vision, and life insurance 401(k) retirement savings plan with employer match ... The Group Director, Utilization Review will perform the functions necessary to support and advance ...

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Showing results 1-20

All JobsMedical Utilization Review JobsMedical Utilization Review Jobs in Michigan

Medical Utilization Review information

See Michigan salary details

$18

$36

$60

How much do medical utilization review jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medical 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 are the key skills and qualifications needed to thrive as a medical utilization review specialist, and why are they important?

To thrive as a Medical Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN), strong analytical abilities, and in-depth knowledge of medical terminology and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as Certified Professional in Healthcare Quality (CPHQ) are commonly required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively reviewing cases and collaborating with providers. These competencies ensure accurate, efficient decision-making that supports both patient care standards and cost-effective healthcare delivery.

Is medical utilization review a stressful job?

Medical utilization review can be stressful due to the need to evaluate complex medical cases, meet strict deadlines, and ensure accurate decisions. The job often requires attention to detail, critical thinking, and sometimes handling difficult interactions with providers or patients. However, stress levels vary depending on workload, work environment, and individual coping skills.

What are some common challenges faced by professionals in medical utilization review, and how can they be addressed?

Professionals in Medical Utilization Review often encounter challenges such as managing high caseloads, staying updated with changing healthcare regulations, and balancing the needs of patients with cost-containment measures. Effective time management and ongoing education in current medical guidelines can help address these issues. Additionally, strong communication skills are essential for collaborating with healthcare providers and insurance companies to ensure appropriate care decisions while maintaining compliance.

How do I get into a medical utilization review?

To become a medical utilization review specialist, candidates typically need a healthcare background such as nursing, medical assisting, or health administration, along with knowledge of insurance policies and medical coding. Certification programs like the Certified Professional Medical Auditor (CPMA) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and billing systems.

What does a medical utilization review specialist do in healthcare?

A medical utilization review specialist evaluates healthcare services to determine their necessity, efficiency, and appropriateness based on established guidelines. They review patient records, collaborate with healthcare providers, and ensure compliance with insurance policies, often using specialized software. This role helps control healthcare costs and ensures quality patient care.

What is the difference between Medical Utilization Review vs Medical Claims Reviewer?

AspectMedical Utilization ReviewMedical Claims Reviewer
CredentialsCertifications like CCM, RHIA, or RHIT often preferredCertifications such as CPC or CCS beneficial
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsInsurance companies, healthcare payers, or claims processing centers
Primary FocusAssessing necessity and appropriateness of medical servicesReviewing and processing insurance claims for payment
Industry UsageCommonly used in healthcare and insurance sectorsPrimarily in insurance and healthcare billing sectors

Medical Utilization Review focuses on evaluating the necessity of medical services, while Medical Claims Review centers on processing insurance claims. Both roles require healthcare knowledge and certifications, but they serve different functions within the healthcare and insurance industries.

What is medical utilization review?

Medical utilization review is a process used by healthcare organizations and insurance companies to evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. The goal is to ensure that patients receive necessary care while avoiding unnecessary or redundant treatments. Utilization review helps control healthcare costs and maintains quality standards by reviewing cases before, during, and after care is provided. The process typically involves nurses, physicians, and other healthcare professionals who assess clinical information to make recommendations or decisions about coverage.

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

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

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

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

Medical Utilization Review jobs near you
Infographic showing various Medical Utilization Review job openings in Michigan as of August 2026, with employment types broken down into 33% Full Time, 33% Part Time, and 34% Contract. Highlights an 100% In-person job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

Utilization Review Nurse

Healthcare Support Staffing

Troy, MI • On-site

Contractor

Re-posted 16 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Company: Molina Healthcare

Location: 880 Long Lake Rd Suite 600 Troy, Michigan 48098

Shift: Daytime hours

Employment: Contract: 1-2 months (possibility of going longer depending on business needs)


Company Job Description/Day to Day Duties:


Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines


Provider appeals and Utilization reviews and assist with Denial Letters 


Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care. 

Qualifications

Minimum Education/Qualifications/Licensures:


Must be an RN 

Utilization Review background in either Managed Care of Provider environment (at least one year) 

Interqual experience 

Other basic computer skills necessary: Microsoft Office, Data Entry, etc. 

Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.

Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.  

Additional Information

Apply now for immediate consideration. After applying, a recruiting consultant will contact you for pre-screening. Please provide your best phone number to contact.

Thanks and look forward to hearing from you!

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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