ZipRecruiter

Log In

1

Utilization Management Jobs in Detroit, MI (NOW HIRING)

TH Medical

Group Director - Utilization Review

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.

TH Medical

Group Director - Utilization Review

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.

Ambition 24Hours Inc

Director Case Management

Detroit, MI · On-site

$103K - $155K/yr

Lead utilization management and medical necessity review processes * Ensure compliance with CMS regulations and Joint Commission standards * Manage patient transition planning and discharge ...

UHS

Lead Utilization Review, Case Manager

Auburn Hills, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Lead Utilization Management (UM) Case Manager has responsibility for daily case assignments to the UM staff and the daily monitoring, tracking, and reporting of Medicare Certificates. The Lead UM ...

UHS

Lead Utilization Review, Case Manager

Auburn Hills, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The Lead Utilization Management (UM) Case Manager has responsibility for daily case assignments to the UM staff and the daily monitoring, tracking, and reporting of Medicare Certificates. The Lead UM ...

TH Medical

Director - Case Management

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...

DMC Receiving Hospital

Director - Case Management

Detroit, MI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention • Transition Management promoting ...

TH Medical

Director - Case Management

Detroit, MI

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...

previous pagenext page

Showing results 21-40

All JobsUtilization Management JobsUtilization Management Jobs in Detroit, MI

Utilization Management information

See Detroit, MI salary details

$36.8K

$84.4K

$153.8K

How much do utilization management jobs pay per year?

As of Aug 12, 2026, the average yearly pay for utilization management in Detroit, MI is $84,440.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,900.00 and $98,600.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in Detroit, MI? The most popular types of Utilization Management jobs in Detroit, MI are:
What are popular job titles related to Utilization Management jobs in Detroit, MI? For Utilization Management jobs in Detroit, MI, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Detroit, MI look for? The top searched job categories for Utilization Management jobs in Detroit, MI are:
What cities near Detroit, MI are hiring for Utilization Management jobs? Cities near Detroit, MI with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Detroit, MI as of August 2026, with employment types broken down into 85% Full Time, 6% Part Time, and 9% Contract. Highlights an 91% In-person, 3% Hybrid, and 6% Remote job distribution, with an average salary of $84,440 per year, or $40.6 per hour.

Utilization Review Supervisor (PCN 1547)

Oakland Community Health Network

Troy, MI • On-site

$70K - $87K/yr

Full-time

Re-posted 7 days ago

Job description

Job Summary

The Supervisor of Utilization Review (UR) oversees the development, implementation, and maintenance of Utilization Review (UR) clinical policies, procedures, and protocols. This position supervises UR Analysts and Acute Care Authorization Analysts and provides clinical and operational oversight for crisis authorizations, concurrent reviews, acute care utilization, high-risk cases, care coordination, and discharge planning.

The UR Supervisor collaborates with providers, hospitals, state facilities, community partners, and internal OCHN departments to ensure appropriate, effective, and efficient use of resources. Responsibilities include supporting NCQA compliance, MDHHS reporting, appeals and due process requirements, case consultation, quality improvement initiatives, and data analysis. The position also participates in management meetings, workgroups, and strategic initiatives while ensuring compliance with regulatory, accreditation, and organizational standards.

Essential Functions

  • Supervise and evaluate Utilization Review (UR) and Acute Care Authorization staff to ensure adherence to clinical criteria, business rules, regulatory requirements, and organizational policies.
  • Provide leadership, oversight, and support for Acute Care Authorization staff responsible for 24/7 operations, ensuring continuity of services, timely decision-making, and compliance with organizational and regulatory requirements.
  • Oversee reviews of admissions, continued stays, and lengths of stay to ensure clinical appropriateness and compliance with reimbursement, accreditation, and regulatory standards.
  • Provide clinical oversight, advocacy, and authorization support for individuals requiring acute care, State Facility placement, enhanced staffing, or higher levels of care.
  • Collaborate with network providers, acute care hospitals, state psychiatric facilities, and interdisciplinary treatment teams to facilitate utilization review activities, continuity of care, and effective discharge planning.
  • Ensure timely and comprehensive review of clinical information, including accurate documentation of decisions and supporting rationale.
  • Lead onboarding, training, coaching, and inter-rater reliability activities, including use of the MCG Parity Tool.
  • Develop, implement, and maintain utilization of review policies, procedures, protocols, and quality improvement initiatives, including those related to NCQA and HSAG requirements.
  • Monitor compliance with authorization, denial, appeal, and reporting requirements established by MDHHS, NCQA, and other regulatory agencies.
  • Analyze, monitor, and report utilization data, including hospital census, admissions, discharges, lengths of stay, recidivism, and staff performance trends to identify improvement opportunities.
  • Participate in organizational committees, workgroups, and initiatives.
  • Represent the Utilization Review department in meetings and special projects assigned by leadership.
  • Participate in quality improvement initiatives, interdisciplinary workgroups, provider collaboration, audits, appeals, and other utilization management and review activities to support organizational performance and regulatory compliance.
  • Perform other duties as assigned.

Job Requirements and Qualifications

Education:

  • Master's degree in mental health field.
  • Training Requirements (licenses, programs, or certificates):

      • Possession and maintenance of a current, unrestricted State of Michigan professional license in one of the following disciplines:
        • Licensed Psychologist (LLP or LP)
        • Licensed Master's Social Worker (LMSW)
        • Licensed Professional Counselor (LPC)
        • Licensed Marriage and Family Therapist (LMFT)
        • Registered Nurse (RN)
        ​Must maintain Child Diagnostic and Treatment Professional (CDTP) eligibility, including 24 hours of annual child-specific training.

Experience Requirements:

  • Minimum of three (3) years of relevant post-graduate clinical experience providing services to adults with mental illness, intellectual or developmental disabilities, and/or substance use disorders, as well as children with serious emotional disturbance and/or intellectual or developmental disabilities.

Preferred Experience:

  • Experience within a Community Mental Health Services Program (CMHSP), Prepaid Inpatient Health Plan (PIHP), Managed Care Organization (MCO), hospital, or behavioral health setting.
  • Experience with NCQA, MDHHS, HSAG, and/or accreditation and regulatory compliance activities.
  • Experience withutilizationofthe MCG Parity Tool.
  • Experience within the Oakland Community Health Network (OCHN) provider network.

Knowledge Requirements: 

  • Knowledge of the Michigan Mental Health Code. 
  • Medicaid rules, regulations, and Michigan Medicaid Provider Manual. 
  • Preference for knowledge of the PIHP responsibilities forutilizationmanagement.
  • Managed Care and Utilization ManagementPrinciples

Job Specific Competencies/Skills

  • Demonstratedstrong interpersonal skills with a proven ability to collaborate effectively in cross-functional and team-oriented environments.
  • Skilled in negotiation and stakeholder engagement, fostering productiverelationships,and achieving mutually beneficial outcomes.
  • Excellent written and verbal communication skills, with the ability to convey complex information clearly and professionally.
  • Proficient in computer applications and project management practices, ensuring efficient coordination, execution, and successful delivery of initiatives.

In addition, the following are preferred competencies:

  • Demonstrated experience in quality assurance and quality monitoring
  • Demonstrated experience in the application of medical necessity
  • Demonstrated experience in data analysis and outcome measurement
  • Demonstrated understanding of the application and outcome measurement of Evidence Based Practices.

Oakland Community Health Network’s Core Competencies:

  • Interacting with others in a way that gives them confidence in one’s intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
  • Making customers and their needs a primary focus of one’s actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
  • Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning)
  • Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
  • Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Additional Information

(Travel required, physical requirements, schedules, etc.):

  • Must have available means of transportation to and from OCHN and for required offsite meetings or site visits.
  • Must be available for meetings and events which may occur outside of standard office hours.
  • Work performed primarily in an office environment.
  • Hybrid (onsite/remote) work schedule available.
  • The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.

OCHN is committed to building a diverse team and fostering an inclusive and equitable culture. We are proud to be an equal opportunity employer that embraces and encourages our employees' differences. This includes (but is not limited to) ability, age, color, family type, gender expression and identity, individual expression, medical conditions, national origin, pregnancy, race, religion, sexual orientation, veteran status, and all other diverse and wonderful characteristics.