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

Hitachi Careers

Aftermarket Account Manager

MI · Remote

This is a full-time salary position that is remote . What We Offer: * Competitive wages, medical ... pipeline reviews * Monitor contract performance, renewal schedules, and customer utilization of ...

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 ...

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 ...

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 ...

ABB

Utility Sales Support

MI · Remote

$17.75 - $23.25/hr

While this is a remote position, candidates must be located in the United States. You will be ... Must have knowledge and skill in utilization of computer databases; empower experience preferred

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Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for remote utilization review in Troy, MI is $40.07, according to ZipRecruiter salary data. Most workers in this role earn between $31.68 and $46.01 per hour, depending on experience, location, and employer.

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 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 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 are the most commonly searched types of Utilization Review jobs in Troy, MI?

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

What are popular job titles related to Remote Utilization Review jobs in Troy, MI?

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

What job categories do people searching Remote Utilization Review jobs in Troy, MI look for?

The top searched job categories for Remote Utilization Review jobs in Troy, MI are:

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

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

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Troy, MI as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $83,354 per year, or $40.1 per hour.

Provider Practice Performance Advisor

Amerihealth Caritas

Southfield, MI • On-site, Remote

Full-time

Re-posted 15 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

129th of 311 rated insurance

Job description

Role Overview: The Performance Practice Advisor supports the Provider Network Management (PNM) team within a POD-based staffing care model, focusing on provider performance, value-based care (VBC) initiatives, and quality outcomes. This role analyzes provider performance data, identifies improvement opportunities, and partners with providers and internal teams to drive improvements in quality, cost, and overall care delivery.

Work Arrangements:

  • Remote – The associate can be located anywhere in Michigan (MI).
  • 50% travel is required to the provider’s location and attend office meetings at our Southfield, MI location.

Responsibilities:

  • Produce all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for the Joint Operating Committee (JOC).
  • Present information to the provider, colleagues, and the executive team in a clear, concise manager
  • Analyze claims data, utilization trends, and patient outcomes to support performance optimization
  • Support provider engagement related to Healthcare Effectiveness Data and Information Set (HEDIS), Total Cost of Care (TCOC), and other performance-based programs
  • Partner with Quality, Provider Network, and Account Executive teams to align strategies and improve provider performance
  • Participate in provider meetings to review gaps in care and develop action plans in collaboration with Provider Network Management (PNM) and Chief Medical Officer (CMO) teams
  • Lead and support performance improvement initiatives and projects aligned with corporate strategy and best practices
  • Identify opportunities using data and collaborate with internal teams to develop and implement targeted intervention strategies
  • Track, monitor, and report on provider action plans and outcomes to measure the effectiveness of initiatives
  • Support network and quality strategy execution across markets
  • Maintain strong cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality teams to achieve performance goals
  • May assist with member outreach efforts and coordination of care-related activities

Education & Experience:

  • Associate's degree required
  • Bachelor’s degree in healthcare administration or related field required
  • 3 years of Account Executive experience or provider engagement experience, demonstrating knowledge of TCOC and Medical Loss Ratio (MLR) analysis, is required.
  • Experience in a variety of provider reimbursement methodologies, including value-based or risk-based contracting
  • Understand quality and provider performance reporting, including HEDIS and other quality measures.

Licensure:

  • Valid driver's license, transportation, and insurance required:

Skills & Abilities:

  • Strong understanding of healthcare regulations, reimbursement models, and quality metrics, specifically in HEDIS and STARS
  • Ability to analyze and interpret complex healthcare data and translate insights into actionable strategies
  • Knowledge of provider operations, including claims coding, payment integrity, credentialing, appeals, and disputes
  • Experience working with value-based care programs and performance measures
  • Excellent communication and collaboration skills with the ability to engage providers and cross-functional teams
  • Strong analytical, problem-solving, and reporting capabilities
  • Ability to manage multiple priorities and drive performance improvement initiatives

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