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:
Previous experience in quality assurance, utilization review, or clinical leadership * Experience ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
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Previous experience in quality assurance, utilization review, or clinical leadership * Experience ... Remote work opportunity * Health, dental, and vision insurance * Paid Time Off * Paid holidays ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... 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
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties • Performs audits in utilization management, care management, member ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
... review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill ... Essential Job Duties Performs audits in utilization management, care management, member assessment ...
Health & Social Services RN - Remote in Michigan
Southfield, MI · Remote
$28.94 - $51.83/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Health & Social Services RN - Remote in Michigan
Southfield, MI · Remote
$28.94 - $51.83/hr
Experience in utilization review, concurrent review or risk management * Background in managing populations with complex medical or behavioral needs * Acute care experience *All Telecommuters will be ...
Medical Coding Specialist
Troy, MI · On-site +1
$65K - $65K/yr
The Medical Coding Specialist provides coding expertise to support Utilization Management ... Quality Review • Perform thorough self review of work prior to submission to ensure accuracy ...
Medical Coding Specialist
Troy, MI · On-site +1
$65K - $65K/yr
The Medical Coding Specialist provides coding expertise to support Utilization Management ... Quality Review • Perform thorough self review of work prior to submission to ensure accuracy ...
Medical Coding Specialist
Troy, MI · Remote
$65K - $65K/yr
Review coding resources, CMS guidance, payer policies, and regulatory requirements to support ... Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer ...
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Medical Coding Specialist
Troy, MI · Remote
$65K - $65K/yr
Review coding resources, CMS guidance, payer policies, and regulatory requirements to support ... Experience supporting health plans, utilization management, prior authorization, DMEPOS, or payer ...
Dealer Success Manager
Detroit, MI · On-site +1
$90K - $115K/yr
S. (Mobile and Remote Service). With Curbee., it's simple: dealerships send the right van to the ... Perform MBRs and QBRs, track key metrics like appointments, utilization, and review results on a ...
Dealer Success Manager
Detroit, MI · On-site +1
$90K - $115K/yr
S. (Mobile and Remote Service). With Curbee., it's simple: dealerships send the right van to the ... Perform MBRs and QBRs, track key metrics like appointments, utilization, and review results on a ...
Supervisor, Clinical Documentation Integrity (CDI) - (Remote)
Livonia, MI · On-site +1
$32.50 - $43.75/hr
... sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work ... May perform CDI reviews to support program during high volume, short staffing periods. Maintains a ...
Supervisor, Clinical Documentation Integrity (CDI) - (Remote)
Livonia, MI · On-site +1
$32.50 - $43.75/hr
... sets and optimal utilization of the 3M CDI software. Responsible for scheduling and work ... May perform CDI reviews to support program during high volume, short staffing periods. Maintains a ...
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:
Location: 100% Remote Employment Type: Full Time Day to Day Responsibilities : * Coordination of ... This includes regular reviews and management of resources time and timesheets. * Define and ...
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Location: 100% Remote Employment Type: Full Time Day to Day Responsibilities : * Coordination of ... This includes regular reviews and management of resources time and timesheets. * Define and ...
Oracle Service Delivery Manager
Troy, MI · On-site +1
Location: 100% Remote Employment Type: Full Time Day to Day Responsibilities : * Coordination of ... This includes regular reviews and management of resources time and timesheets. * Define and ...
Oracle Service Delivery Manager
Troy, MI · On-site +1
Location: 100% Remote Employment Type: Full Time Day to Day Responsibilities : * Coordination of ... This includes regular reviews and management of resources time and timesheets. * Define and ...
Clinical Quality Assurance Manager
Farmington Hills, MI · Remote
$80K - $85K/yr
Remote Eligible- Must be located in Michigan within distance of Farmington Hills.Position Summary ... This role will be responsible for reviewing clinical documents to evaluate their adherence to ...
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Clinical Quality Assurance Manager
Farmington Hills, MI · Remote
$80K - $85K/yr
Remote Eligible- Must be located in Michigan within distance of Farmington Hills.Position Summary ... This role will be responsible for reviewing clinical documents to evaluate their adherence to ...
Clinical Quality Assurance Manager
Farmington Hills, MI · Remote
$80K - $85K/yr
Remote Eligible- Must be located in Michigan within distance of Farmington Hills.Position Summary ... This role will be responsible for reviewing clinical documents to evaluate their adherence to ...
Clinical Quality Assurance Manager
Farmington Hills, MI · Remote
$80K - $85K/yr
Remote Eligible- Must be located in Michigan within distance of Farmington Hills.Position Summary ... This role will be responsible for reviewing clinical documents to evaluate their adherence to ...
Lead Software Asset Management Specialist
Detroit, MI · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Lead Software Asset Management Specialist
Detroit, MI · On-site +1
Analyze utilization and renewal readiness * Support AI license tracking and cost analysis ... Support compliance reviews and audits * Interpret licensing terms and requirements Automation ...
Remote Utilization Review information
See Detroit, MI salary details
$21.18 - $25.46
2% of jobs
$25.46 - $29.75
9% of jobs
$32.68 is the 25th percentile. Wages below this are outliers.
$29.75 - $34.03
21% of jobs
The median wage is $37.50 / hr.
$34.03 - $38.31
23% of jobs
$38.31 - $42.60
13% of jobs
$45.93 is the 75th percentile. Wages above this are outliers.
$42.60 - $46.88
10% of jobs
$46.88 - $51.16
8% of jobs
$51.16 - $55.45
5% of jobs
$55.45 - $59.73
5% of jobs
$59.73 - $64.01
2% of jobs
$64.01 - $68.30
2% of jobs
$21
$41
$68
How much do remote utilization review jobs pay per hour?
What are the key skills and qualifications needed to thrive in the Remote Utilization Review position, and why are they important?
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
What does a typical day look like for someone in a Remote Utilization Review role?
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
What is a Remote Utilization Review job?
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
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Other
Re-posted 7 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.
- Organization: Corporate Services
- Department: Central Utilization Mgt
- Shift: Day Job
- Union Code: Not Applicable