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Remote Utilization Review Manager Jobs in Michigan

Lancesoft

Registered Nurse

Detroit, MI · On-site +1

$30 - $35/hr

Two to four years of clinical experience which may include post-acute care, home care, acute patient care, discharge planning, case management, and utilization review, and caring for aging population ...

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Remote Utilization Review Manager information

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

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

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

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Manager, and why are they important?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are the most commonly searched types of Remote Utilization Review jobs in Michigan? The most popular types of Remote Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Utilization Review Manager jobs in Michigan? For Remote Utilization Review Manager jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Michigan look for? The top searched job categories for Remote Utilization Review Manager jobs in Michigan are:
Remote Utilization Review Manager jobs near you

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

Corporate Services

Troy, MI • Remote

Other

Posted 3 days 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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