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Remote Utilization Review Manager Jobs in Howell, MI

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Remote Utilization Review Manager information

See Howell, MI salary details

$36.5K

$85.2K

$156.7K

How much do remote utilization review manager jobs pay per year?

As of Aug 18, 2026, the average yearly pay for remote utilization review manager in Howell, MI is $85,166.00, according to ZipRecruiter salary data. Most workers in this role earn between $55,700.00 and $102,500.00 per year, depending on experience, location, and employer.

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 Howell, MI?

The most popular types of Remote Utilization Review jobs in Howell, MI are:

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For Remote Utilization Review Manager jobs in Howell, MI, the most frequently searched job titles are:

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What cities near Howell, MI are hiring for Remote Utilization Review Manager jobs?

Cities near Howell, MI with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

RN, telephonic Clinical Case Manager

Managed Medical Review Organization

Novi, MI • Remote

Full-time

Posted 22 days ago

Job description

About the Role
We are looking for an experienced RN Clinical Case Manager to support a disability claim review program. In this role, you will guide members through a collaborative case management process built on assessment, planning, care coordination, and ongoing evaluation. Your work directly supports improvement in members' (patients) disabling and co-morbid conditions and helps maximize their employability. You will own your caseload from start to finish and be responsible for an efficient, timely, and complete case management process.


What You'll Do
•    Determine the appropriate case management track for each assigned case.
•    Conduct telephonic clinical assessments covering activities of daily living, psycho-social factors, recent hospitalizations, current clinical status, treatment plans and medications, treating physicians, special needs, and the appropriate outreach interval for each case.
•    Develop customized, member-specific clinical case management plans.
•    Perform ongoing periodic telephonic outreach at intervals set during the initial clinical assessment.
•    Request and track receipt of the records and documentation needed to identify ongoing case management needs.
•    Build and maintain a case management resource library to provide members with information relevant to their conditions.
•    Assess whether a review is needed for a member's return to their own occupation, and identify the appropriate physician specialty when it is.
•    Collaborate with vocational specialists during the case management process when needed.
•    Conduct thorough, ongoing quality review of all case documentation and ensure completeness and accuracy of case paperwork.
•    Communicate with members, physicians, employers, and clients as appropriate.
•    Enter case activities into the case management system accurately and within client-required timeframes.
•    Maintain compliance with applicable practice standards and guidelines, including strict confidentiality and HIPAA adherence.


What You'll Bring
•    Unrestricted RN licensure, without sanctions.
•    Current certification in case management or a related field, or the ability to qualify for certification testing within six months of hire.
•    Minimum of five years of clinical experience.
•    Minimum of five years of case management experience in one or more of the following: medical, workers' compensation, auto, or disability case management.
•    Working knowledge of diagnostic coding (ICD-10).
•    Strong critical thinking, decision-making, and organizational skills with close attention to detail.
•    Ability to meet deadlines and turnaround times consistently.
•    Ability to work independently as well as within a team.
•    Computer literacy, including solid working knowledge of Microsoft Word and Excel.
•    Strong written, verbal, and telephonic communication skills, with the ability to manage multiple priorities.
•    Bachelor's degree in nursing or a health-related field.
•    Working knowledge of the insurance industry, medical claims, and/or disability claims.
•    Experience with Lean production management.


Work Environment
You will be working in an approved remote environment within the states of: Michigan, Illinois, Florida, Texas, or  Minnesota. Stressful conditions may arise when the workload becomes more demanding than usual.