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Utilization Case Manager Jobs in Michigan (NOW HIRING)

Wedgwood Christian Services

SUD Case Manager

Muskegon, MI · On-site

$47K - $53K/yr

The Case Manager provides intensive case management services to assigned clients in the community ... utilization reviews, compliance with service delivery criteria and reporting requirements for each ...

Wedgwood Christian Services

SUD Case Manager

Muskegon, MI · On-site

$47K - $53K/yr

The Case Manager provides intensive case management services to assigned clients in the community ... utilization reviews, compliance with service delivery criteria and reporting requirements for each ...

Wedgwood Christian Services

SUD Case Manager

Muskegon, MI · On-site

$47K - $53K/yr

The Case Manager provides intensive case management services to assigned clients in the community ... utilization reviews, compliance with service delivery criteria and reporting requirements for each ...

Memorial Healthcare

RN Case Manager

Owosso, MI · On-site

Prior Case Management or utilization review experience preferred. Case Management certification preferred. ESSENTIAL PHYSICAL REQUIREMENTS: Must be able to sit or stand for long periods of time; be ...

Memorial Healthcare

RN Case Manager

Owosso, MI · On-site

Prior Case Management or utilization review experience preferred. Case Management certification preferred. ESSENTIAL PHYSICAL REQUIREMENTS: Must be able to sit or stand for long periods of time; be ...

Peckham, Inc.

Case Manager Specialist

Battle Creek, MI · On-site

... potential utilization of assistive technology and other job accommodations * Work to identify ... PREFERRED QUALIFICATIONS * 1-year related experience in case management * Licensed Professional ...

Peckham

Case Manager Specialist

Battle Creek, MI

... potential utilization of assistive technology and other job accommodations * Work to identify ... PREFERRED QUALIFICATIONS * 1-year related experience in case management * Licensed Professional ...

Henry Ford Health System

Case Manager-Social Worker

Detroit, MI · On-site

$21.50 - $28.25/hr

Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...

Henry Ford Health System

Case Manager-Social Worker

Detroit, MI · On-site

$21.50 - $28.25/hr

Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...

Henry Ford Health System

Case Manager-Social Worker

Detroit, MI · On-site

$21.50 - $28.25/hr

Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...

Henry Ford Health System

Case Manager-Social Worker

Detroit, MI · On-site

$21.50 - $28.25/hr

Knowledge of computers, Electronic Health Records, data base systems and utilization review/case management documentation systems. Desire to work collaboratively and proactively with healthcare teams ...

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Showing results 21-40

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Michigan

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Michigan?

For Utilization Case Manager jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Michigan look for?

The top searched job categories for Utilization Case Manager jobs in Michigan are:

What cities in Michigan are hiring for Utilization Case Manager jobs?

Cities in Michigan with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Michigan as of August 2026, with employment types broken down into 84% Full Time, 13% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution.

SUD Case Manager

Wedgwood Christian Services

Muskegon, MI • On-site

$47K - $53K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Job description

The Case Manager provides intensive case management services to assigned clients in the community. They will coordinate resources between multiple agencies, meetings for clients, and provide education to clients and family on Medicated-Assisted Treatment and other applicable topics.
RESPONSIBILITIES:
  • Develop case management plans for each client, working with the Clinical Supervisor and other team members when necessary. Prioritize client needs appropriately by seeking feedback from all involved parties.
  • Provide a holistic approach, with specific attention and support to include family in programming, engaging family/natural supports in treatment, and empowering family/natural supports to help with decision making.
  • Facilitate multiple case aspects to meet the health and human service needs of the client.
  • Work to develop and maintain a resource listing for the applicable service area.
  • Develop case management objectives and a quarterly case plan collaboratively with the client and other resources if applicable. In addition, facilitate a quarterly Case Review Meeting, with all parties in attendance, to discuss the client's case management objectives and plan for the next quarter.
  • Track information, beginning at intake and admission, through treatment and into aftercare, which becomes part of the statistical data bank of Wedgwood. Track data as necessary for the program's funding and PIHP or program requirements.
  • Assure that all authorizations/reauthorizations or documentation/paperwork requirements are clinically appropriate and timely (according to contracts) for all county, State of Michigan, Court, and Managed Care Agencies.
  • At client discharge, coordinate aftercare plans to ensure treatment continuity for the clients psychiatric, medical, and therapeutic care.
  • Responsible for quality assurance compliance, including but not limited to participating in peer supervision, peer utilization reviews, compliance with service delivery criteria and reporting requirements for each individual served.
  • Responsible for timely Quality Assurance compliance as related to employee's roles and functions.
  • Meet regularly with and make use of knowledge and skills of his/her supervisor through direct supervision, case review, and field observation as outlined by the program specifications.
  • Participate in educational opportunities and trainings provided by the agency and through CMH that meet program requirements for continued development of skills and clinical expertise.
  • Participate in the collaborative process of ongoing program development and provide input regarding suggested changes.
  • Provide timely services as indicated in the program specifications and complete documentation requirements within the timeframes and content standards established by best practices.
  • Assist with the professional growth of new hires by allowing job shadowing as needed.
  • For the purposes of coordination of care, follow community partner, PIHP, CMH, and agency guidelines when providing treatment with patients receiving Medication-Assisted Treatment (MAT) or other medical treatment. Provide education to clients, family, and other involved parties on MAT.
  • Professional Growth
    • Keep informed of current resource availability in identified service area(s).
    • Utilize educational opportunities and resources offered by the agency and through the profession for continued development of skills and clinical expertise, (conferences, In-services, Therapist Meetings, etc.)
    • Use the knowledge and skills of his/her supervisor to increase understanding of treatment programming and to further professional development.
  • Responsible for timely Quality Assurance compliance as related to employee's roles and functions.
  • Other duties as assigned

QUALIFICATIONS:
  • Bachelor's degree in Social Work, Psychology or another associated human service profession required.
  • Clinical experience working with adolescents and/or families preferred.
  • Prior experience working with an interdisciplinary team in a residential treatment setting preferred.
  • Subscription to the Statement of Faith of Wedgwood Christian Services and agreement with the goal, purpose and objectives of the agency.

HOURS OF WORK: 40 Hours per week (24 hour per week Admin. and 16 hours per week direct care)
Compensation: $47,424 to $53,497/yr
BENEFITS:
  • 403(b) retirement plan with employer match
  • Medical Plans with great coverage options
  • Free supplemental virtual PCP care with medical plan
  • Flexible Spending Accounts
  • Health Savings Accounts
  • Dental and Vision plans
  • Pet insurance
  • Legal insurance
  • A Locally Partnered Employee Assistance Program
  • Competitive paid time off
  • Direct deposit
  • Federal Student Loan Forgiveness through PSLF
  • Paid Holidays
  • We also offer a variety of employer paid benefits for full time staff
  • Short term disability
  • Long term disability
  • Life insurance up to 2x your annual salary
  • No-cost, employer paid training and re-certification provided to staff
  • Wedgwood has full gymnasium and state-of-the art 24-hour wellness center filled with a wide variety of workout equipment, available to staff at no cost.
  • Walking trail that leads around the beautiful campus.
  • Through community partnerships, Wedgwood employees and in some cases family members, are eligible for application and tuition fee discounts for several local colleges and universities.

Wedgwood Christian Services
Since 1960, Wedgwood Christian Services has been dedicated to aggressively taking on the toughest problems facing children and families through residential care, counseling services, and community programs. Our goal is to support and help restore the physical, social, intellectual, emotional and spiritual well-being of children, adults, and families in our community.
Wedgwood is a local West Michigan agency, with offices bordering the coast of the beautiful Lake Michigan. Our main office is headquartered in Grand Rapids, Michigan, ranked in the top tier of the Best Places to Live in America according to Business Insider.
Mission: Wedgwood Christian Services extends God's love to youth, adults, and families through professional counseling and educational services.
Core Values: Integrity, Compassion, Excellence, and Diversity
#WCSC

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