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Remote Insurance Utilization Review Jobs in Michigan

Lancesoft

Registered Nurse

Detroit, MI · On-site +1

$30 - $35/hr

... utilization review, and caring for aging population in the home or post-acute care setting, etc ... One year health insurance plan experience or managed care environment preferred. * Registered Nurse ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Ypsilanti, MI · On-site +1

$51.75 - $63/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Detroit, MI · On-site +1

$52.50 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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Remote Insurance Utilization Review information

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.

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 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.
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

Coordinator-Utilization Review(Clinical Coding)/Full Time/Remote

Corporate Services

Troy, MI • Remote

Other

Posted 19 hours ago

Job description

In this position you will be reviewing patient charts to determine if pre-elective surgical cases should be boarded as inpatient instead of outpatient.  You will also review the CPTs that were boarded for meeting inpatient on the CMS inpatient list and the InterQual inpatient list based on payer criteria used.

Hours are Monday - Friday from 830am until 5pm with no weekends

EDUCATION AND EXPERIENCE: 

  • RHIT, RHIA, or related coding certification required. 
  • Minimum 3-5 years of clinical experience preferred. 
  • Previous utilization management or case management experience preferred. 

CERTIFICATIONS/LICENSURES REQUIRED:

  •  RHIT, RHIA, or related coding certification required.
Additional Information
  • Organization: Corporate Services
  • Department: Central Utilization Mgt
  • Shift: Day Job
  • Union Code: Not Applicable

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