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Remote Insurance Utilization Review Jobs in Michigan

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Remote Insurance Utilization Review information

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

What are the most commonly searched types of Insurance Utilization Review jobs in Michigan? The most popular types of Insurance Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Insurance Utilization Review jobs in Michigan? For Remote Insurance Utilization Review jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Michigan look for? The top searched job categories for Remote Insurance Utilization Review jobs in Michigan are:
What cities in Michigan are hiring for Remote Insurance Utilization Review jobs? Cities in Michigan with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Michigan as of May 2026, with employment types broken down into 94% Full Time, 2% Part Time, and 4% Contract. Highlights an 100% Remote job distribution.
Utilization Review Assistant- Remote

Utilization Review Assistant- Remote

Hurley Medical Center

Flint, MI • On-site, Remote

Full-time

Posted 4 days ago

Hurley Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 27 frontline employees who took The Breakroom Quiz

524th of 990 rated hospitals

Job description

Job Description
This position will assist in the coordination of all activities related to insurance authorizations process for the Patient Access Utilization Review (UR) department. Activities may consist of collaborating with various medical staff and Medical Center personnel, participating in non-clinical appeals process, obtaining status updates on all outstanding appeals, monitoring and tracking of all financial activities related to the UR team. Participates in quality management and continuous quality improvement activities. Perform all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under the direction of the Director of Patient Access or designee who reviews work for effectiveness and compliance with established standards, policies, and procedures.
Responsibilities
  1. Perform necessary authorization-related tasks in an accurate and timely manner. This includes utilization of the Epic EMR system efficiently and effectively and providing sufficient and clear documentation of all actions taken.
  2. Assist in the initial authorization approval process by communicating with various payers and other internal Medical Center personnel and submitting pertinent documentation to the payers for approval consideration.
  3. Assist in submitting concurrent and retrospective reviews to appropriate payers. This may require following up with physicians and other health care providers to review admissions and continued stays not meeting criteria.
  4. Stay abreast of health care benefit inclusions and exclusions for all financial classes, benefit changes, review requirements, and other pertinent regulations influencing the Medical Center.
  5. Assist with appeals of denied days by third-party reviewers throughout each stage of available reconsideration/appeal mechanisms.
  6. Review charts for instances of over/under utilization of ancillary services to ensure optimum quality of care and maximum reimbursement.
  7. Collaborate with the Patient Access/Registration, Medical Records, Billing teams, and other hospital areas to ensure post discharge completion of all information necessary to generate timely billing.
  8. Assist in drafting letters to third-party review entities and medical staff members and working with the Utilization Review Coordinators for approval and finalization of such letters.
  9. Assist in identification, development, and implementation of new procedures designed to increase operating efficiency.
  10. Review level of care for patients (with UR Coordinators and medical staff approval) regarding inpatient, observation, and outpatient care and relate this information to the Revenue Cycle teams for billing purposes.
  11. Maintain all primary assignments (based on financial goals assigned to the UR department). This consists of working on Discharge Not Billed (DNB), Claim Edits, and Stop Bill work queues or reports to accomplish timely accounts resolution.
  12. Perform other related duties as required/assigned. Utilizes new improvements and/or technologies that relate to job assignment.

Qualifications
  • Associate's degree in healthcare or related field required (Bachelor's degree preferred).
  • Two (2) years of healthcare experience in authorizations, coding, patient registration, billing, or utilization review.
  • Knowledge of hospital patient care admission processes and third party payer utilization requirements.
  • Strong background and knowledge of payer authorizations and referrals.
  • Ability to communicate effectively in oral and written modes.
  • Ability to interact courteously and effectively with all levels of the Medical Center staff, patients, medical staff, external agency representatives, and the public.

NOTE: If the incumbent is skillfully prepared and actively pursuing a degree, they will be required to obtain minimally an Associate's degree within one (1) year of accepting the position.

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