ZipRecruiter

Log In

2

Remote Rn Utilization Review Nurse 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 ... Registered Nurse with current unrestricted Michigan Registered Nurse license required. NIT001 Meet ...

next page

Showing results 1-20

People also search for

All JobsRemote Rn Utilization Review Nurse JobsRemote Rn Utilization Review Nurse Jobs in Michigan

Remote Rn Utilization Review Nurse information

See Michigan salary details

$18

$36

$60

How much do remote rn utilization review nurse jobs pay per hour?

As of May 28, 2026, the average hourly pay for remote rn utilization review nurse 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 as a Remote RN Utilization Review Nurse, and why are they important?

To thrive as a Remote RN Utilization Review Nurse, you need an active RN license, strong clinical knowledge, and experience in case management or utilization review. Proficiency with healthcare review software, electronic health records (EHRs), and familiarity with insurance guidelines or regulatory requirements is vital. Excellent communication, critical thinking, and time management skills distinguish top performers in remote settings. These skills enable nurses to make accurate, timely decisions about patient care while ensuring compliance and efficient resource utilization.

What are some common challenges faced by Remote RN Utilization Review Nurses, and how can they be addressed?

Remote RN Utilization Review Nurses often encounter challenges such as managing large caseloads, maintaining effective communication with interdisciplinary teams, and staying updated with ever-changing insurance guidelines. Balancing productivity expectations while ensuring thorough case reviews can be demanding. To address these challenges, nurses can utilize robust organizational tools, participate in ongoing training sessions, and leverage regular virtual meetings to stay connected with colleagues and supervisors, ensuring both efficiency and high-quality patient care.

What is a Remote RN Utilization Review Nurse?

A Remote RN Utilization Review Nurse is a registered nurse who evaluates medical records and healthcare services from a remote location to ensure that patients receive appropriate, necessary, and cost-effective care. They review treatment plans, check for compliance with insurance and healthcare guidelines, and often work with healthcare providers, insurance companies, and patients to coordinate care. This role typically involves assessing the medical necessity of procedures, authorizing services, and helping prevent unnecessary treatments or hospitalizations.

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

AspectRemote Rn Utilization Review NurseRemote Rn Case Manager
CertificationsRN license, possibly UR or CCM certificationRN license, CCM or other case management certification
Work EnvironmentReviewing medical records, insurance guidelines, and authorizationsCoordinating patient care, discharge planning, and resource management
Employer & Industry UsageHealth insurance companies, third-party administratorsHospitals, health plans, healthcare providers

Remote Rn Utilization Review Nurses primarily evaluate medical necessity for insurance approvals, focusing on documentation and guidelines. In contrast, Remote Rn Case Managers coordinate patient care, discharge planning, and resource allocation. Both roles require RN licensure and related certifications but differ in daily tasks and work focus.

What are popular job titles related to Remote Rn Utilization Review Nurse jobs in Michigan? For Remote Rn Utilization Review Nurse jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Rn Utilization Review Nurse jobs in Michigan look for? The top searched job categories for Remote Rn Utilization Review Nurse jobs in Michigan are:
What cities in Michigan are hiring for Remote Rn Utilization Review Nurse jobs? Cities in Michigan with the most Remote Rn Utilization Review Nurse job openings:
Remote Rn Utilization Review Nurse jobs near you
Utilization Review Medical Director

Utilization Review Medical Director

Integra Partners

Troy, MI • On-site, Remote

$250K - $250K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 27 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. This full-time, salaried 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:
  • Full-time 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: $250,000.00/annually
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. Integra Partners is a wholly owned subsidiary of Point32Health.
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.

Apply