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Remote Utilization Review Manager Jobs in Michigan

Integra Partners

Director of Utilization Management

Troy, MI · On-site +1

$160K - $160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:

Integra Partners

Utilization Management Coordinator

Troy, MI · On-site +1

$19/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ... 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

Demonstrated experience in case management, utilization review, value-based care, and/or discharge ... If applying for a remote or hybrid role, this includes remote work expectations related to ...

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Remote Utilization Review Manager information

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?

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 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 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:

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

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

Remote Utilization Review Manager jobs near you

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

Henry Ford Health System

Troy, MI • On-site, Remote

Full-time

Re-posted 23 days ago

Henry Ford Health rating

7.0

Company rating: 7.0 out of 10

Based on 565 frontline employees who took The Breakroom Quiz

414th of 888 rated healthcare providers

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.

What Henry Ford Health employees say

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Benefits

Hours and flexibility

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About Henry Ford Health

Sourced by ZipRecruiter

Henry Ford Health provides a full continuum of services from Primary and Preventative care, to Complex and Cpecialty care, Health Insurance, a full suite of home health offerings, Virtual care, Pharmacy, Eye care and other Healthcare retail. It is one of the Nation’s leading Academic Medical Centers, recognized for Clinical excellence in Cancer care, Cardiology and Cardiovascular Surgery, Neurology and Neurosurgery, Orthopedics and Sports medicine, and Multi organ transplants. Consistently ranked among the top five NIH funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of Health Professionals, Henry Ford Health trains more than 4,000 Medical students, Residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most Diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Detroit, MI, US

Year founded

1915

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