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Remote Psychiatric Utilization Review Jobs in Michigan

Legion Health

$50K - $150K/yr

... with and supervise psychiatric mental health nurse practitioners through secure telehealth ... Conduct chart reviews and provide timely guidance on diagnoses, treatment plans, medication ...

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.

New

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.

New

Legion Health

$150K - $300K/yr

... reviews. Our vision is to pioneer a new era of medicine by delivering world-class psychiatry. We ... Fully remote within the United States. * Schedule: Full-time or part-time positions are available.

Legion Health

$300K - $500K/yr

Perform comprehensive psychiatric assessments, including mental-health history, medical history ... Collaborate with other psychiatrists through consultations and case reviews. * Use technology and ...

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Remote Psychiatric Utilization Review information

What is a remote psychiatric utilization review?

A Remote Psychiatric Utilization Review position involves evaluating mental health treatment plans and services to ensure they are medically necessary and meet insurance or regulatory guidelines. Professionals in this role typically review clinical documentation, assess the appropriateness of care, and make recommendations regarding the coverage of psychiatric services, all while working remotely. They collaborate with healthcare providers, insurance companies, and sometimes patients, to facilitate quality care and manage costs. Strong knowledge of mental health diagnoses, treatment protocols, and insurance policies is essential for success in this position.

What are the key skills and qualifications needed to thrive as a remote psychiatric utilization review specialist?

To thrive as a Remote Psychiatric Utilization Review specialist, you need a clinical background in nursing, social work, or mental health counseling, typically with relevant licensure (such as RN, LCSW, or LPC) and experience in psychiatric care. Familiarity with utilization review platforms, electronic health records (EHRs), and managed care systems is essential, along with certifications like CCM (Certified Case Manager) being advantageous. Strong analytical thinking, attention to detail, and effective verbal and written communication skills are crucial for evaluating cases and coordinating with providers. These competencies ensure accurate assessments, compliance with regulations, and optimal patient outcomes while managing costs in a remote work environment.

What are some common challenges faced by professionals in remote psychiatric utilization review roles, and how can they be addressed?

Professionals in Remote Psychiatric Utilization Review often encounter challenges such as interpreting clinical documentation remotely, ensuring timely case reviews, and maintaining effective communication with providers and insurance companies. Staying organized and developing strong time-management skills are key to managing caseloads efficiently. Regularly participating in team meetings and leveraging secure digital communication tools can help bridge the gap between remote team members and facilitate collaboration. Continuous education on evolving mental health regulations and payer guidelines is also essential to remain effective in the role.

What is the difference between Remote Psychiatric Utilization Review vs Remote Mental Health Case Manager?

AspectRemote Psychiatric Utilization ReviewRemote Mental Health Case Manager
CredentialsLicensed Psychiatrist, Psychologist, or Certified Utilization Review ProfessionalLicensed Clinical Social Worker, Mental Health Counselor, or Case Management Certification
Work EnvironmentReviewing medical records, insurance documentation, and making utilization decisions remotelyCoordinating care, assessing client needs, and providing support remotely
Employer & Industry UsageInsurance companies, health plans, and utilization review organizationsHealthcare providers, community agencies, and insurance companies

Remote Psychiatric Utilization Review focuses on evaluating medical necessity for psychiatric services, often within insurance and healthcare organizations. In contrast, Remote Mental Health Case Managers actively coordinate and support patient care. Both roles require mental health credentials but differ in daily tasks and focus areas.

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

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

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

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

What cities in Michigan are hiring for Remote Psychiatric Utilization Review jobs?

Cities in Michigan with the most Remote Psychiatric Utilization Review job openings:

Remote Psychiatric Utilization Review jobs near you
Infographic showing various Remote Psychiatric Utilization Review job openings in Michigan as of August 2026, with employment types broken down into 5% Internship, 86% Full Time, and 9% Part Time. Highlights an 100% Remote job distribution.

Utilization Review Medical Director (Contract)

Integra Partners

Troy, MI • Remote

$150/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 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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