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Utilization Management Nurse Jobs in Michigan (NOW HIRING)

CVS Health

MI · On-site

$29.10 - $62.32/hr

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. UM Nurse Consultant Fully Remote- WFH Schedule : Monday-Friday 10:30AM- 7:30PM Position ...

McLaren

Registered Nurse Care Manager PRN

Lapeer, MI · On-site

Works collaboratively with physicians, nursing, members of the multidisciplinary team (such as Home ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...

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Utilization Management Nurse information

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$34K

$78K

$142.1K

How much do utilization management nurse jobs pay per year?

As of Aug 15, 2026, the average yearly pay for utilization management nurse in Michigan is $77,993.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,200.00 and $91,100.00 per year, depending on experience, location, and employer.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

What are the key skills and qualifications needed to thrive as a utilization management nurse?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

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

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

More about Utilization Management Nurse jobs

What are the most commonly searched types of Utilization Management Nurse jobs in Michigan?

The most popular types of Utilization Management Nurse jobs in Michigan are:

What are popular job titles related to Utilization Management Nurse jobs in Michigan?

For Utilization Management Nurse jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Utilization Management Nurse jobs in Michigan look for?

The top searched job categories for Utilization Management Nurse jobs in Michigan are:

What cities in Michigan are hiring for Utilization Management Nurse jobs?

Cities in Michigan with the most Utilization Management Nurse job openings:

What are popular job titles related to Utilization Management Nurse jobs in MI?

For Utilization Management Nurse jobs in MI, the most frequently searched job titles are:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, and 4% Contract. Highlights an 91% Physical, 4% Hybrid, and 5% Remote job distribution, with an average salary of $77,993 per year, or $37.5 per hour.

Utilization Management Nurse Consultant

CVS Health

Lansing, MI • On-site

$29.10 - $62.32/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 13 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,335 frontline employees who took The Breakroom Quiz

89th of 112 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.

UM Nurse Consultant

Fully Remote- WFH

Schedule : Monday-Friday 10:30AM- 7:30PM

Position Summary:

UM Nurse Consultant

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

-Must have 3+ years of Med Surg experience as an RN in the hospital setting

  • Active and unrestricted RN licensure in state of residence

  • Able to work in multiple IT platforms/systems

  • 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)

Preferred Qualifications

  • Knowledge of Medicare/Medicaid

  • Managed care experience

  • Utilization Management experience

Education

Associates Degree in Nursing required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 08/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

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