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Utilization Care Manager Jobs in Michigan (NOW HIRING)

McLaren

Registered Nurse Care Manager PRN

Lapeer, MI · On-site

... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Three years of acute hospital care experience • American Case Management Certification (ACM) or ...

Volunteers of America

Home Care Manger

Lansing, MI · On-site

$73K - $85K/yr

Work with Purpose. Join The Senior Community Care of Michigan PACE as a Home Care Manager in ... Prioritizes utilization of homecare staffing needs to reflect actual enrolled participant ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

UHS

Utilization Review Manager

Grand Rapids, MI

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

UHS

Utilization Review Manager

Grand Rapids, MI

The Utilization Manager is responsible for directing and overseeing the Utilization Program for ... Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory ...

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Utilization Care Manager information

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What are popular job titles related to Utilization Care Manager jobs in Michigan? For Utilization Care Manager jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Michigan look for? The top searched job categories for Utilization Care Manager jobs in Michigan are:
What cities in Michigan are hiring for Utilization Care Manager jobs? Cities in Michigan with the most Utilization Care Manager job openings:
Utilization Care Manager jobs near you

Registered Nurse Care Manager PRN

McLaren USA

Lapeer, MI • On-site

Other

Posted 3 days ago

New

Job description

Position Summary: Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost efficient resource utilization, preventing readmissions and unnecessary emergency room visits. Works collaboratively with physicians, nursing, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other resources internal and external to the organization.
Essential Functions and Responsibilities as Assigned:
1. Performs care coordination assessments for initial assessment of patients with 24 hrs. of admission. assessments for readmission and transition planning.
2. Works collaboratively with the social worker and other disciplines to ensure a safe, appropriate, and timely transition to the next level of care, taking into consideration the patient's available resources.
3. Assesses patient/family needs to reduce barriers and formulate discharge plans (e.g., LOS barriers to D/C).
4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers.
5. Reviews current DRG/LOS identified within Cerner to assess discharge planning needs with providers and identifies which family member is the point of contact.
Qualifications:
Required
  • State licensure as a Registered Nurse (RN)
  • Bachelor's degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within five years of accepting position.
  • Three years of acute hospital care experience
• American Case Management Certification (ACM) or obtain certification when eligible as defined by the Association Case Management Association, and maintenance of continuing education requirement
Preferred:
  • Experience in utilization management/case management, critical care, or patient outcomes/quality management
  • Certification in Case Management Certification (ACM or CCM)
  • Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)

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