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Remote Bcba Utilization Review Jobs in Michigan (NOW HIRING)

Acorn Health

Hybrid BCBA

Cadillac, MI · On-site +1

$76K - $94K/yr

This position has additional flexibility expecting 3 days in clinic and allowing 2 days remote. We ... Monitor and review client programs to analyze data, measure progress and make necessary changes to ...

Ourhrconnect

$309K - $413K/yr

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.

Ourhrconnect

$309K - $413K/yr

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.

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Remote Bcba Utilization Review information

What is a Remote BCBA Utilization Review?

Remote BCBA Utilization Review jobs involve Board Certified Behavior Analysts (BCBAs) who review and assess the medical necessity and effectiveness of Applied Behavior Analysis (ABA) therapy services, usually for insurance companies or healthcare organizations. These professionals work remotely to evaluate clinical documentation, ensure compliance with treatment guidelines, and approve or deny service requests based on established criteria. The role helps ensure that clients receive appropriate care while also managing costs for payers. Strong analytical and communication skills are essential, as is up-to-date BCBA certification.

What are the key skills and qualifications needed to thrive as a Remote BCBA Utilization Review?

To excel as a Remote BCBA Utilization Review specialist, you need Board Certified Behavior Analyst (BCBA) certification, in-depth knowledge of applied behavior analysis (ABA), and experience with clinical documentation standards. Familiarity with electronic health record (EHR) systems, utilization review platforms, and insurance authorization processes is typically required. Strong analytical thinking, attention to detail, and effective written communication distinguish top performers in this role. These competencies ensure accurate service reviews, compliance with payer requirements, and support for quality client care in a remote environment.

What are some common challenges faced by a Remote BCBA Utilization Review professional, and how can they be managed?

Remote BCBA Utilization Review professionals often encounter challenges such as balancing thorough case evaluations with productivity targets and adapting to varying documentation standards from different providers. Effective time management and strong communication skills are key to addressing these challenges. Additionally, staying current with payer guidelines and collaborating closely with clinical teams can help ensure accurate and efficient reviews, ultimately supporting high-quality care for clients.

What is the difference between Remote Bcba Utilization Review vs Remote Bcba Case Manager?

AspectRemote Bcba Utilization ReviewRemote Bcba Case Manager
CertificationsBCBA, possibly additional utilization review credentialsBCBA, case management certifications often preferred
Work EnvironmentReviewing medical and treatment plans remotely, focusing on insurance and authorizationCoordinating care, managing cases, and supporting clients remotely
Employer & IndustryHealthcare, insurance companies, behavioral health providersBehavioral health agencies, healthcare organizations

Both roles require BCBA certification and involve remote work, but the Utilization Review focuses on evaluating treatment plans for insurance approval, while the Case Manager manages ongoing client care and services. Understanding these differences helps professionals choose the right career path in behavioral health.

What are the most commonly searched types of Bcba Utilization Review jobs in Michigan?

The most popular types of Bcba Utilization Review jobs in Michigan are:

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

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Remote Bcba Utilization Review jobs near you
Infographic showing various Remote Bcba 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.

Utilization Review Medical Director (Contract)

Integra Partners

Troy, MI • On-site, Remote

$150/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Job description

The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. Role functions within a structured, high-volume authorization review queue and requires adherence to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan-specific criteria, internal policies, and regulatory requirements. This role is best suited for physicians who thrive in a process-driven environment and are committed to consistency, compliance, and evidence-based decision making.
The Utilization Review Medical Director's responsibilities include but are not limited to:
  • Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria, including LCDs, Medicaid Manuals, InterQual, MCG, internal medical policies, and health plan requirements.
  • Function within a real-time review queue and maintain continuous case throughput in alignment with organizational turnaround and productivity standards.
  • Evaluate clinical documentation, identify missing elements, and render determinations supported by clear clinical rationale.
  • Review cases escalated by UM staff and/or UM Leadership when criteria do not apply to the enrollee's unique clinical situation or when clinical judgment is required.
  • When appropriate, consult with external board-certified reviewers, engage with ordering practitioners, or conduct additional clinical dialogue prior to rendering a determination.
  • Participate in Peer-to-Peer (P2P) discussions, including maintaining availability for scheduled appointment times.
  • Document all clinical decisions clearly, concisely, and consistently in accordance with internal SOPs, NCQA standards, and regulatory expectations.
  • Maintain inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program.
  • Serve as a clinical resource for UM team, providing guidance on clinical interpretation, criteria application, and complex case review.
  • Support internal and external audit activities as needed, including NCQA accreditation, health plan audits, and state Medicaid reviews.
  • Notify leadership of observed trends, potential quality concerns, or opportunities to strengthen criteria alignment or operational workflows.
  • Maintain up-to-date knowledge of Medicare, Medicaid, DMEPOS policies, clinical standards of care, and regulatory updates relevant to UM.
Requirements:
  • MD or DO degree
  • Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
  • Eligible for participation in Medicare, Medicaid, and other federally funded programs; no current or past OIG or state sanctions
  • Experience performing utilization management or clinical review activities
  • Strong written and verbal communication skills with emphasis on documentation accuracy
  • Ability to work effectively in a high-volume, queue-based workflow with daily review expectations
  • Familiarity with electronic UM systems and authorization platforms
  • Experience with DMEPOS reviews
  • Experience with NCQA UM accreditation standards
  • Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans

Working Conditions and Additional Expectations:
  • Remote role requiring consistent availability during standard business hours and responsiveness to daily assignments.
  • Case volume and mix vary; continuous throughput and timely review completion are required.
  • Must maintain a quiet, secure, and compliant environment for reviewing PHI and participating in P2P calls.
  • Secondary employment or consulting arrangements are permitted only if they do not interfere with the full-time expectations and require disclosure/approval.
  • Daily accountability measures, productivity monitoring, and adherence to all UM workflows are required.

Salary: $150.00/Hourly
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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