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Nursing Utilization Review Jobs in Michigan (NOW HIRING)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of Independent Review Organization (IRO) cases. The primary responsibilities include reviewing clinical ...

UHS

Utilization Review Manager

Grand Rapids, MI

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Utilization Review Manager

Grand Rapids, MI

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... LMSW, LPC, RN or LVN licensure in the state of Michigan required. 3-5 years direct clinical ...

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Nursing Utilization Review information

What is nursing utilization review?

Nursing Utilization Review is a process where nurses evaluate the necessity, efficiency, and appropriateness of healthcare services provided to patients. These nurses review medical records, treatment plans, and patient progress to ensure that care meets established guidelines and is cost-effective. They play a key role in helping healthcare organizations maintain quality care while controlling costs and ensuring regulatory compliance. Utilization review nurses often work for hospitals, insurance companies, or government agencies.

What are the key skills and qualifications needed to thrive as a nursing utilization review nurse?

To thrive as a Nursing Utilization Review Nurse, you need strong clinical knowledge, critical thinking, and a current RN license, often complemented by experience in case management or utilization review. Familiarity with healthcare coding systems (ICD-10, CPT), utilization management software, and regulatory compliance tools is typical. Excellent communication, attention to detail, and negotiation skills make someone stand out in this position. These skills ensure accurate assessment of medical necessity, optimize resource use, and support patient care quality within regulatory guidelines.

What are some common challenges faced by nurses working in utilization review, and how can they be managed?

Nurses in utilization review often face challenges such as balancing the need for cost-effective care with advocating for patients' clinical needs and navigating complex insurance guidelines. They must critically review medical records while ensuring compliance with evolving regulatory standards. Effective time management and strong communication skills are essential for liaising between healthcare providers, insurance companies, and patients. Ongoing education and collaboration with interdisciplinary teams can help address these challenges and ensure high-quality, patient-centered care.

What is the difference between Nursing Utilization Review vs Nursing Case Management?

AspectNursing Utilization ReviewNursing Case Management
Primary FocusAssessing medical necessity and appropriateness of care for insurance or healthcare providersCoordinating patient care plans and ensuring optimal health outcomes
Work EnvironmentInsurance companies, healthcare facilities, utilization review organizationsHospitals, clinics, community health settings
CredentialsRN license, often with certifications in utilization review or case managementRN license, case management certification often preferred

While both roles involve nursing expertise, Nursing Utilization Review primarily focuses on evaluating the necessity of care for insurance purposes, whereas Nursing Case Management emphasizes coordinating patient care to improve health outcomes. Both roles require RN licensure and related certifications, but their daily tasks and work environments differ.

How to get into nursing utilization review as a nurse?

To become a nursing utilization review nurse, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can improve job prospects, and familiarity with healthcare management software is often required.

What does a nursing utilization review nurse do?

A nursing utilization review nurse evaluates patient records to determine the necessity, appropriateness, and efficiency of healthcare services. They review medical documentation, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical guidelines. Certification in case management or utilization review is commonly required.

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

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

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

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

What cities in Michigan are hiring for Nursing Utilization Review jobs?

Cities in Michigan with the most Nursing Utilization Review job openings:

Nursing Utilization Review jobs near you
Infographic showing various Nursing Utilization Review job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, 1% Temporary, 4% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

RN Utilization Review Nurse

Healthcare Support Staffing

Troy, MI

$33 - $37/hr

Full-time

Re-posted 23 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

Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN Utilization Review Nurse position for you!


Company Job Description/Day to Day Duties:

  • Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare.
  • Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing 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 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 policy for 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 members including Behavioral Health and Long Term Care.


Hours for this Position:

  • Mon-Fri: 8:30am - 5pm


Advantages of this Opportunity:

  • Great salary between $33 - 37!
  • Great benefits!!!
  • Fun and positive work environment!
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 (at least one year)
  • Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
  • 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.
  • Great typing and data entry skills
Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call John Wood 407-478-0332 ext 225

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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