ZipRecruiter

Log In

2

Remote Utilization Review Jobs in Rochester, MI (NOW HIRING)

Belle, LLC

Senior Product Engineer

Detroit, MI · Remote

As these issues arise, a team of remote nurses coordinate care with other healthcare providers ... Mentor engineers through code review, pairing, and design discussion * Identify high-leverage ...

Huntington

Commercial Portfolio Manager- Senior

Detroit, MI · On-site +1

$70K - $140K/yr

Conduct portfolio reviews with senior management and analyze existing portfolio to identify trends ... Understanding and utilization of credit skills for credit decision making, monitoring, and managing ...

fng

Software Developer

Warren, MI · On-site +1

This is a remote position. Responsibilities * Design, develop, test, and deploy full-stack features ... Participate in technical design discussions, code reviews, testing, documentation, and deployment ...

fng

Software Developer

Warren, MI · On-site +1

This is a remote position. Responsibilities * Design, develop, test, and deploy full-stack features ... Participate in technical design discussions, code reviews, testing, documentation, and deployment ...

fng

Software Developer

Warren, MI · On-site +1

This is a remote position. Responsibilities * Design, develop, test, and deploy full-stack features ... Participate in technical design discussions, code reviews, testing, documentation, and deployment ...

Amgen

Field Reimbursement Manager

Detroit, MI · On-site +1

Review patient-specific information in cases where the site has specifically requested assistance ... General office demands - Remote, Work from Home. * One to two home office days per week. * Must be ...

COMPASSUS

Insurance Specialist

Warren, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...

COMPASSUS

Insurance Specialist

Farmington Hills, MI · Remote

$20 - $35/hr

Compassus This is a remote position for candidates located in the Central Time Zone. Position ... Reviews the insurance verification and completes the authorization process within established time ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Rochester, MI

Remote Utilization Review information

See Rochester, MI salary details

$19

$38

$63

How much do remote utilization review jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote utilization review in Rochester, 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 in remote utilization review?

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 remote utilization review do?

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?

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.

What are popular job titles related to Remote Utilization Review jobs in Rochester, MI? For Remote Utilization Review jobs in Rochester, MI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Rochester, MI look for? The top searched job categories for Remote Utilization Review jobs in Rochester, MI are:
What cities near Rochester, MI are hiring for Remote Utilization Review jobs? Cities near Rochester, MI with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Rochester, MI as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 25% In-person, and 75% Remote job distribution, with an average salary of $80,950 per year, or $38.9 per hour.

RN, telephonic Clinical Case Manager

Managed Medical Review Organization

Novi, MI • Remote

Full-time

Posted 14 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.