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Optum Utilization Review Jobs in Michigan (NOW HIRING)

Integrated Autism Centers

Medical Biller

Warren, MI · On-site

$23 - $26/hr

... utilization to keep services uninterrupted. * Payment Posting & Reconciliation: Post ERAs/EOBs ... reviews, working with clinical staff to meet deadlines. What We're Looking For: * 1+ years of ...

UnitedHealth Group

Specialty Pharmacist Per Diem

Owosso, MI · On-site

$44.09 - $78.70/hr

Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

UnitedHealth Group

Specialty Pharmacist Per Diem

Owosso, MI · On-site

$44.09 - $78.70/hr

Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

divvyDOSE

Specialty Pharmacist Full Time

Marshall, MI · On-site

$44 - $79/hr

Specialty Pharmacist Explore opportunities with CPS, part of the Optum family of businesses. We're ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

UMR

Specialty Pharmacist Full | , Michigan

Marshall, MI · On-site

$44 - $79/hr

Specialty Pharmacist Explore opportunities with CPS, part of the Optum family of businesses. We're ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

UMR

Specialty Pharmacist Per Diem

Owosso, MI · On-site

$44.09 - $78.70/hr

Per Diem Specialty Pharmacist Explore opportunities with CPS, part of the Optum family of ... Review and manage specialty medication therapies for complex, chronic, or high-cost conditions

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All JobsOptum Utilization Review JobsOptum Utilization Review Jobs in Michigan

Optum Utilization Review information

See Michigan salary details

$18

$36

$60

How much do optum utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for optum 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 in an Optum Utilization Review?

To succeed in an Optum Utilization Review role, candidates typically need a clinical background such as a registered nurse (RN) or social worker (LCSW), along with experience in case management and knowledge of utilization management principles. Familiarity with medical review software, electronic health records (EHRs), and utilization management platforms like InterQual or Milliman is often expected, as well as active state licensure or relevant certifications (e.g., CCM). Strong analytical thinking, attention to detail, and effective communication are critical soft skills for collaborating with healthcare providers and internal teams. These competencies are vital to ensure appropriate use of healthcare resources, compliance with regulations, and optimal patient outcomes.

What is an Optum Utilization Review?

An Optum Utilization Review job involves assessing medical treatments and services to ensure they are medically necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this role review patient cases, collaborate with healthcare providers, and apply clinical criteria to determine coverage approvals. They help optimize patient care while managing healthcare costs. Typically, these positions require a background in nursing or healthcare and knowledge of utilization management policies.

What does an Optum Utilization Review do?

In an Optum Utilization Review position, you can expect a mix of reviewing patient medical records, communicating with healthcare providers to gather additional information, and making decisions on the medical necessity and appropriateness of services. The role often involves using clinical guidelines and established protocols to ensure coverage aligns with insurance policies, as well as accurate documentation of findings and recommendations. You'll collaborate with physicians, other case managers, and sometimes directly with members, in a structured yet dynamic environment. While much of the work may be independent and computer-based, teamwork and communication are essential to coordinate care and resolve complex cases.

What are the most commonly searched types of Optum Utilization Review jobs in Michigan? The most popular types of Optum Utilization Review jobs in Michigan are:
What are popular job titles related to Optum Utilization Review jobs in Michigan? For Optum Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Optum Utilization Review jobs in Michigan look for? The top searched job categories for Optum Utilization Review jobs in Michigan are:
Optum Utilization Review jobs near you
Infographic showing various Optum Utilization Review job openings in Michigan as of July 2026, with employment types broken down into 88% Full Time, and 12% Part Time. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

Medical Biller

Integrated Autism Centers

Warren, MI • On-site

$23 - $26/hr

Full-time

Re-posted 15 days ago

Job description

Medical Biller — Integrated Autism Centers

About Us: Integrated Autism Centers provides high-quality autism diagnostic and therapy services (ABA, speech, and occupational therapy) to children and families across Metro Detroit. We're looking for a sharp, dependable Medical Biller to own our revenue cycle from authorization to payment.

The Role: This is a high-trust, full-time position for someone who knows their way around insurance billing and takes pride in clean claims and a healthy A/R. You'll be the point person for our billing operations — submitting claims, chasing denials, tracking authorizations, and making sure every service we deliver gets paid. The ideal candidate is detail-obsessed, persistent with payers, and comfortable owning the full billing cycle with minimal hand-holding.

Key Responsibilities:
  • Claims Submission: Prepare and submit clean claims for ABA, speech, and OT services to commercial payers and Medicaid; verify CPT codes, modifiers, units, and documentation before submission.
  • Denials & Appeals: Work denials and rejections promptly; prepare appeals and resubmissions, communicate with payers, and resolve issues to keep revenue flowing.
  • Insurance Authorizations: Submit, track, and follow up on authorizations and reauthorizations; monitor expiration dates and unit utilization to keep services uninterrupted. 
  • Payment Posting & Reconciliation: Post ERAs/EOBs, reconcile payments against expected reimbursement, and flag underpayments or contract discrepancies.
  • A/R Management: Monitor aging reports, follow up on outstanding claims, and keep days-in-A/R low; provide regular reporting to leadership on collections and claim status.
  • Eligibility & Benefits Verification: Verify patient coverage and benefits at intake and re-verify as needed; communicate patient responsibility clearly to families.
  • Payer Documentation Requests: Gather and submit clinical documentation in response to payer records requests and pre-payment reviews, working with clinical staff to meet deadlines.

What We're Looking For:
  • 1+ years of medical billing experience; ABA, behavioral health, or pediatric therapy billing strongly preferred.
  • Working knowledge of CPT/ICD-10 coding, modifiers, and payer-specific billing rules; familiarity with BCBSM, Blue Care Network, HAP, UHC/Optum, Priority Health, and Michigan Medicaid is a strong plus.
  • Experience with practice management/EMR systems and clearinghouses (CentralReach experience a plus).
  • Strong follow-through and persistence — comfortable getting payers on the phone and staying on a claim until it's resolved.
  • Excellent attention to detail and organizational skills; able to manage multiple payers, deadlines, and priorities at once.
  • Clear written and verbal communication with families, staff, and insurance companies.
  • Discretion and reliability when handling PHI and confidential financial information; understanding of HIPAA requirements.