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Medical Utilization Review Jobs in Michigan (NOW HIRING)

Corewell 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 ...

Healthcare Support Staffing

Care Review Clinician

Troy, MI · On-site

$33 - $37/hr

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

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Medical Utilization Review information

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How much do medical utilization review jobs pay per hour?

As of Sep 5, 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 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 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.

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.

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.

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 Reviewer (CMR) can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and billing systems.

Is medical utilization review a good job?

Medical utilization review is a healthcare role focused on evaluating the necessity and efficiency of medical services, often requiring knowledge of insurance policies and clinical guidelines. It offers opportunities for stable employment, typically involves administrative and analytical skills, and may require certification such as the Certified Professional Medical Auditor (CPMA). The job can provide a predictable schedule and work-from-home options, making it a viable career choice for those interested in healthcare administration.

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 1% As Needed, 76% Full Time, 16% Part Time, 6% Contract, and 1% Nights. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

Utilization Mgmt Spec

Corewell Health

Southfield, MI • On-site

Part-time

Medical, Vision, Retirement

Re-posted yesterday

Key responsibilities

  • Access insurance websites and complete duties to obtain authorization numbers for payment.

  • Provide clerical support for Utilization Management, including sorting faxes and mail, obtaining authorization numbers, and following up on outstanding cases.

  • Answer incoming calls, triage calls to appropriate personnel, and complete follow-up or problem solve issues received via phone, fax, or email.

Corewell Health rating

6.9

Company rating: 6.9 out of 10

Based on 782 frontline employees who took The Breakroom Quiz

453rd of 898 rated healthcare providers

Job description

Job Summary
Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement.
Essential Functions
  • Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment.
  • 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 outpatient or inpatient status.
  • Utilizes electronic medical record work queues that support Utilization Management functions.
  • Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
  • Problem solves issues that are received via phone, fax or email.
  • Other duties as assigned.

Qualifications
Required
  • High School Diploma or G.E.D. completion required.

Preferred
  • Post high school training and/or academic coursework leading toward associate or bachelor's degree
  • Two years of healthcare experience
  • Competency and comprehension of basic medical terminology. Well-developed computer skills and/or business-related software/application literacy.

About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
  • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
  • On-demand pay program powered by Payactiv
  • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
  • Optional identity theft protection, home and auto insurance
  • Traditional and Roth retirement options with service contribution and match savings
  • Eligibility for benefits is determined by employment type and status

Primary Location
SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd
Department Name
Utilization Management - Diversified East WB Mkt
Employment Type
Part time
Shift
Day (United States of America)
Weekly Scheduled Hours
20
Hours of Work
Variable
Days Worked
Monday - Saturday
Weekend Frequency
Variable weekends
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.

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