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Utilization Management Nurse Jobs in Michigan (NOW HIRING)

McLaren

Registered Nurse Care Manager

Mount Clemens, 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 ...

UHS

Utilization Review Manager

Grand Rapids, MI

A minimum of three years' experience in Utilization Management Required. License: State of Michigan licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse RN. About Universal Health Services ...

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Utilization Management Nurse information

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How much do utilization management nurse jobs pay per year?

As of Sep 4, 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 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 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.

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 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 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.

More about Utilization Management Nurse jobs

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

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

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

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

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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, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $77,993 per year, or $37.5 per hour.

Registered Nurse Care Manager

McLaren

Mount Clemens, MI • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Job description

Department: Care Management
Daily Work Times: 0800-1600
Shift: Day
Scheduled Bi-Weekly Hours: 80
Benefits:
• 403(b)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
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.
6. Assesses risk of readmission for specified patient populations and initiates assigned interventions that will enhance the patient's ability to successfully transition along the care continuum.
7. Performs discharge planning coordination/referral by making appropriate referrals to social services, ancillary departments, outpatient case management, DME, post-acute placement, and other outside agencies per Standard Operating Procedure (SOP).
#LI-KH1
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

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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About McLaren

Sourced by ZipRecruiter

McLaren Group is globally renowned as one of the world’s most illustrious high-technology brands. Since the formation of McLaren Racing in 1963, McLaren has been pioneering and innovating in the competitive world of Formula 1, forging a formidable reputation which has seen the racing team win 20 World Championships and over 180 races. The Group has built on its successful racing expertise and diversified to include a global, high-performance sports car business, McLaren Automotive, and a game-changing technology and innovation business, McLaren Applied. Despite the broadening of the group’s business interests, McLaren’s goal remains singular: we exist to win in everything we do.

Industry

Automobile dealers and manufacturing

Company size

10,000+ Employees

Headquarters location

Woking, Surrey, GB

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