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Remote Utilization Management Jobs in Detroit, MI

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:

Integra Partners

Medical Coding Specialist

Troy, MI · Remote

$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:

Amgen

Field Reimbursement Manager

Detroit, MI · On-site +1

... utilization management criteria, insurance forms & procedures, benefits investigation, prior ... General office demands - Remote, Work from Home. * One to two home office days per week. * Must be ...

COMPASSUS

Insurance Specialist

Dearborn, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Utilization management experience and pre-certification helpful. * Customer service experience ...

New

COMPASSUS

Insurance Specialist

Warren, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Utilization management experience and pre-certification helpful. * Customer service experience ...

New

COMPASSUS

Insurance Specialist

Ann Arbor, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Utilization management experience and pre-certification helpful. * Customer service experience ...

New

COMPASSUS

Insurance Specialist

Farmington Hills, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Utilization management experience and pre-certification helpful. * Customer service experience ...

New

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All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Detroit, MI

Remote Utilization Management information

See Detroit, MI salary details

$21

$41

$68

How much do remote utilization management jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for remote utilization management in Detroit, MI is $41.86, according to ZipRecruiter salary data. Most workers in this role earn between $33.08 and $48.08 per hour, depending on experience, location, and employer.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Detroit, MI? The most popular types of Utilization Management jobs in Detroit, MI are:
What are popular job titles related to Remote Utilization Management jobs in Detroit, MI? For Remote Utilization Management jobs in Detroit, MI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Detroit, MI look for? The top searched job categories for Remote Utilization Management jobs in Detroit, MI are:
What cities near Detroit, MI are hiring for Remote Utilization Management jobs? Cities near Detroit, MI with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Detroit, MI as of August 2026, with employment types broken down into 82% Full Time, and 18% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,064 per year, or $41.9 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 9 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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