In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
In this position you will be reviewing patient charts to determine if pre-elective surgical cases ... Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES ...
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
Director of Utilization Management
Troy, MI · On-site +1
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
Director of Utilization Management
Troy, MI · Remote
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
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Director of Utilization Management
Troy, MI · Remote
$160K - $160K/yr
Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain ... Career development opportunities Remote Opportunities We are actively seeking new colleagues in:
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 ...
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 ...
Registered Nurse - Progressive Care
Detroit, MI · On-site +1
$81K - $139K/yr
... outcomes utilization. Practice includes directing other providers. Partners with the patient ... The Nurse II Progressive Care Registered Nurse (RN) is responsible for providing competent ...
New
Registered Nurse - Progressive Care
Detroit, MI · On-site +1
$81K - $139K/yr
... outcomes utilization. Practice includes directing other providers. Partners with the patient ... The Nurse II Progressive Care Registered Nurse (RN) is responsible for providing competent ...
New
... Nurse (RN) to serve our patient population in the navigation, prevention and management of their ... Welcome patients into continuous care program(s) and review benefits and services included
Quick apply
... Nurse (RN) to serve our patient population in the navigation, prevention and management of their ... Welcome patients into continuous care program(s) and review benefits and services included
... Nurse (RN) to serve our patient population in the navigation, prevention and management of their ... Welcome patients into continuous care program(s) and review benefits and services included
... Nurse (RN) to serve our patient population in the navigation, prevention and management of their ... Welcome patients into continuous care program(s) and review benefits and services included
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Quick apply
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Quick apply
Assess whether a review is needed for a member's return to their own occupation, and identify the ... Work Environment You will be working in an approved remote environment within the states of:
Be Seen First
Remote RN Case Manager [MI RNs only]
Detroit, MI · Remote
$35 - $39/hr
Job Title: RN Case Manager Location: 100% Remote Duration: 12+ months License Required: Active & unrestricted Michigan RN license The RN Case Manager serves as the primary point of contact for ...
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Remote RN Case Manager [MI RNs only]
Detroit, MI · Remote
$35 - $39/hr
Job Title: RN Case Manager Location: 100% Remote Duration: 12+ months License Required: Active & unrestricted Michigan RN license The RN Case Manager serves as the primary point of contact for ...
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Remote RN Case Manager
Detroit, MI · Remote
$36 - $39/hr
Remote RN Case Manager Location: 100% Remote Duration: 12 Months License Required: Michigan State RN License ESSENTIAL DUTIES AND RESPONSIBILITIES (Other duties may be assigned.) * Lead the ...
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Be Seen First
Remote RN Case Manager
Detroit, MI · Remote
$36 - $39/hr
Remote RN Case Manager Location: 100% Remote Duration: 12 Months License Required: Michigan State RN License ESSENTIAL DUTIES AND RESPONSIBILITIES (Other duties may be assigned.) * Lead the ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical ... Essential Job Duties • Performs audits in utilization management, care management, member ...
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
RN (Registered Nurse)
Detroit, MI · Remote
$20 - $25/hr
Remote Duration: 12 months Description: * The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan ...
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RN (Registered Nurse)
Detroit, MI · Remote
$20 - $25/hr
Remote Duration: 12 months Description: * The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan ...
Case Manager Registered Nurse (LTSS) - Field MI (Wayne and Macomb County)
Sterling Heights, MI · Remote
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Case Manager Registered Nurse (LTSS) - Field MI (Wayne and Macomb County)
Sterling Heights, MI · Remote
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Review claims data, clinical records, and assessment tools to evaluate member needs and benefit ... Remote Work Expectations * This is a remote role with 25-50% travel required, candidates must have ...
Remote Utilization Review Rn information
See Rochester Hills, MI salary details
$19.69 - $23.68
2% of jobs
$23.68 - $27.66
9% of jobs
$30.38 is the 25th percentile. Wages below this are outliers.
$27.66 - $31.64
21% of jobs
The median wage is $34.86 / hr.
$31.64 - $35.62
23% of jobs
$35.62 - $39.61
13% of jobs
$42.70 is the 75th percentile. Wages above this are outliers.
$39.61 - $43.59
10% of jobs
$43.59 - $47.57
8% of jobs
$47.57 - $51.55
5% of jobs
$51.55 - $55.54
5% of jobs
$55.54 - $59.52
2% of jobs
$59.52 - $63.50
2% of jobs
$19
$38
$63
How much do remote utilization review rn jobs pay per hour?
As of Aug 7, 2026, the average hourly pay for remote utilization review rn in Rochester Hills, MI is $38.92, according to ZipRecruiter salary data. Most workers in this role earn between $30.77 and $44.71 per hour, depending on experience, location, and employer.
What are the key skills and qualifications needed to thrive as a remote utilization review RN?
To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.
What is a remote utilization review RN?
A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.
What is the difference between Remote Utilization Review Rn vs Remote Case Manager Rn?
| Aspect | Remote Utilization Review Rn | Remote Case Manager Rn |
|---|---|---|
| Certifications | RN license, Utilization Review certification (e.g., URAC) | RN license, Case Management certification (e.g., CCM) |
| Work Environment | Reviewing medical records, insurance policies, telehealth platforms | Coordinating patient care, discharge planning, telehealth |
| Employer & Industry | Insurance companies, healthcare organizations | Hospitals, insurance providers, healthcare agencies |
Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.
What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?
Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Rochester Hills, MI? For Remote Utilization Review Rn jobs in Rochester Hills, MI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Rochester Hills, MI look for? The top searched job categories for Remote Utilization Review Rn jobs in Rochester Hills, MI are:
What cities near Rochester Hills, MI are hiring for Remote Utilization Review Rn jobs? Cities near Rochester Hills, MI with the most Remote Utilization Review Rn job openings:
Coordinator-Utilization Review(Clinical Coding)/Full Time/Remote
Troy, MI • On-site, Remote
Full-time
Re-posted 12 days ago
Henry Ford Health rating
7.0
Based on 564 frontline employees who took The Breakroom Quiz
416th of 887 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:
CERTIFICATIONS/LICENSURES REQUIRED:
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.
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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