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Remote Utilization Management Nurse Jobs in Michigan

Bcbsa

Director, Trade Client Relations

Three Rivers, MI · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Integra Partners

Medical Coding Specialist

Troy, MI · On-site +1

$65K - $65K/yr

The Medical Coding Specialist provides coding expertise to support Utilization Management ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:

Imh

RN Care Manager - PRN

Almont, MI · Remote

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

Belle, LLC

Nurse Practitioner: Remote Urgent Care

Detroit, MI · Remote

$109K - $151K/yr

Belle trains and manages a network of nail technicians or "Belle Technicians" who provide in-home ... As these issues arise, a team of remote nurses coordinate care with other healthcare providers ...

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Remote Utilization Management Nurse information

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$18

$36

$60

How much do remote utilization management nurse jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for remote utilization management 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 is the difference between Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

What is a remote utilization management nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What does a remote utilization management nurse do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

What are the key skills and qualifications needed to thrive as a remote utilization management nurse?

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by remote utilization management nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.
More about Remote Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Michigan? The most popular types of Utilization Management Nurse jobs in Michigan are:
What are popular job titles related to Remote Utilization Management Nurse jobs in Michigan? For Remote Utilization Management Nurse jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Nurse jobs in Michigan look for? The top searched job categories for Remote Utilization Management Nurse jobs in Michigan are:
What cities in Michigan are hiring for Remote Utilization Management Nurse jobs? Cities in Michigan with the most Remote Utilization Management Nurse job openings:
Remote Utilization Management Nurse jobs near you
Infographic showing various Remote Utilization Management Nurse job openings in Michigan as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

Director of Utilization Management

Integra Partners

Troy, MI • On-site, Remote

$160K - $160K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

Integra's Utilization Management (UM) division is looking for an experienced individual to direct the clinical and non-clinical utilization management teams for a managed care organization. This individual will play a key role in delivering UM to our health plan clients, growing our UM business, and working with the organization to operationalize our UM program.
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The Director of Utilization Management's responsibilities include but are not limited to:
  • Prepare and maintain Utilization Review Plan policies and procedures
  • Obtain or maintain certification or license in states when performing Utilization Review
  • Work with Chief Medical Director to establish, adopt, and review UM benefit and medical necessity decision-making criteria
  • Manage UM Department, clinical and non-clinical staff, to ensure timely review of prior authorizations and appeals
  • Responsible for UM-related quality improvement activities, including conducting audits to ensure consistent application of medical criteria, evaluating program for improvement opportunities and annual IRR testing
  • Communicate and work with company executives and management to ensure alignment of UM program with departments and corporate initiatives
  • Participate on Quality Improvement Committee and UM Committee to oversee clinical oversight of UM Department
  • Work in conjunction with Account Managers and external liaison for clients to ensure program meets contractual delegated activities and performance requirements
  • As needed, represent the UM team in support of client-facing efforts such as business development and/or business review activities.
  • Help consult on existing and/or prospective client UM programs
  • Participate in technology related activities and implement solutions across UM Department
  • Oversee and execute the workplan to maintain NCQA certification
  • Build and manage the administrative and clinical resources to ensure the UR program functions efficiently and effectively, meeting all internal, legal, regulatory, and/or certification standards
  • Build and maintain a staffing model that is flexible and appropriate to scale as the business scales
  • Manage internal policies and procedures and workflows to ensure compliance, effectiveness, and best in class clinical operations
  • Owner of the third party technology and configuration of medical management software to ensure optimal operation
  • Responsible for day-to-day team management to ensure on-time, on-budget delivery of all operations • As needed, represent the UM team in support of client-facing efforts such as business development and/or business review activities
  • Help consult on existing and/or prospective client UM programs

WHAT WILL YOU LEARN IN THE FIRST 6 MONTHS?
  • In the first six months you will learn the function of the UM department within the organization and be fully integrated in your position, company, and team
  • You will have a full and complete understanding of our metric requirements and reporting capabilities
  • You will understand your role and responsibilities, to foster excellence in team performance
  • You will develop team goals and monitor progress, as you build relationships with your team to encourage and understand their needs and abilities
  • During this time, you will set measurable goals for personal development and growth

WHAT WILL YOU ACHIEVE IN THE FIRST 12 MONTHS?
  • You will create a people first approach to your team, easily identifying the strengths and weakness of each team member and how to best support them
  • You will be contributing your skills and knowledge to meet your department's metrics and goals

EXPERIENCE:
  • Bachelor's degree in area of specialty, preferred
  • Minimum of 10 years of UM management experience in a managed care setting
  • Experience with UM NCQA or URAC certification/accreditation
  • Experience with leading and managing teams of clinical and non-clinical staff
  • Analytical ability and clinical knowledge in order to assess medical records, identify trends, and report findings
  • Communication skills, verbal and written, needed to convey information clearly and consistently
  • Interpersonal skills necessary to develop and maintain a wide variety of cooperative working relationships

Salary: $160,000.00/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.
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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