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 ...
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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 ...
Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required. Additional Information Must live ...
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Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required. Additional Information Must live ...
Utilization Review background in either Managed Care of Provider environment (at least one year) RN License in Michigan Interqual experience (at least one year) Minimum 2-4 years of clinical practice.
Utilization Review background in either Managed Care of Provider environment (at least one year) RN License in Michigan Interqual experience (at least one year) Minimum 2-4 years of clinical practice.
Summary Description Oversees hospital utilization performance improvement and operational management of the site Case Management Department to promote effective utilization of hospital resources ...
Summary Description Oversees hospital utilization performance improvement and operational management of the site Case Management Department to promote effective utilization of hospital resources ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$109K/yr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. * Partner with ...
Warren, MI · On-site
$150 - $200/hr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. Partner with ...
Warren, MI · On-site
$150 - $200/hr
Own the OEM Portal D360 enhancement agenda, including prioritization, roadmap communication, dependency management, decision-making, and alignment with dealer utilization goals. Partner with ...
Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...
Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...
Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...
Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination ...
Detroit, MI · On-site
Integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention • Transition Management promoting ...
Detroit, MI · On-site
Integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention • Transition Management promoting ...
Integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention • Transition Management promoting ...
Integrates national standards for case management scope of services including: • Utilization Management supporting medical necessity and denial prevention • Transition Management promoting ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
$250/hr
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
$250/hr
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Detroit, MI · On-site
The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and hospital leadership. The Physician ...
Farmington Hills, MI · On-site
Utilization Management Coordinator Part Time- 20 hours a week. Scope of work Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and ...
Farmington Hills, MI · On-site
Utilization Management Coordinator Part Time- 20 hours a week. Scope of work Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and ...
Minimum of 3 years of utilization management or utilization review experience in an acute care, health plan, or managed care setting preferred. * Demonstrated proficiency in the application and ...
Minimum of 3 years of utilization management or utilization review experience in an acute care, health plan, or managed care setting preferred. * Demonstrated proficiency in the application and ...
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Troy, MI · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...
Troy, MI · On-site
Registered Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
Troy, MI · On-site
Registered Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...
$36.8K - $47.4K
15% of jobs
$47.4K - $58.1K
8% of jobs
$59.6K is the 25th percentile. Wages below this are outliers.
$58.1K - $68.7K
15% of jobs
The median wage is $75.4K / yr.
$68.7K - $79.4K
20% of jobs
$79.4K - $90K
11% of jobs
$95.3K is the 75th percentile. Wages above this are outliers.
$90K - $100.6K
13% of jobs
$100.6K - $111.3K
5% of jobs
$111.3K - $121.9K
3% of jobs
$121.9K - $132.5K
4% of jobs
$132.5K - $143.2K
3% of jobs
$143.2K - $153.8K
3% of jobs
$36.8K
$84.4K
$153.8K
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.
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.
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.
The most popular types of Utilization Management jobs in Detroit, MI are:
For Utilization Management jobs in Detroit, MI, the most frequently searched job titles are:
The top searched job categories for Utilization Management jobs in Detroit, MI are:
Cities near Detroit, MI with the most Utilization Management job openings:
$103K - $155K/yr
Contractor
Re-posted 3 days ago
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Director Case Management – Full-Time
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Location: Detroit, Michigan
Setting: Acute Care Hospital
Employment Type: Full-Time
Experience Level: Director Level
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Guaranteed Hours
40 hours per week
Estimated Pay Rate
$103,000 – $155,000 annually
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Shift Information
Number of Shifts: 5 shifts per week
Shift Start Time: 08:00 AM
Shift End Time: 05:00 PM
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┌─────────────────────────┐
Job Overview
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We are seeking an experienced Director of Case Management to oversee hospital utilization management, transition management, care coordination, and operational leadership within a high-volume acute care hospital setting. This role is responsible for driving performance improvement, ensuring compliance with regulatory standards, and optimizing patient throughput and resource utilization.
The Director will lead multidisciplinary teams to ensure safe, efficient, and timely patient care delivery while supporting revenue cycle integrity, denial prevention, and hospital operational effectiveness.
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Key Responsibilities
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• Oversee Case Management Department operations and staffing
• Lead utilization management and medical necessity review processes
• Ensure compliance with CMS regulations and Joint Commission standards
• Manage patient transition planning and discharge coordination
• Monitor patient throughput, avoidable days, and length of stay metrics
• Implement performance improvement and quality initiatives
• Provide physician and staff education on utilization and documentation
• Coordinate care across interdisciplinary hospital teams
• Support revenue cycle processes and denial prevention efforts
• Ensure regulatory compliance across all case management functions
• Develop departmental goals, policies, and operational procedures
• Participate in audits, compliance reviews, and reporting initiatives
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Requirements
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• Bachelor’s degree in Nursing or health-related field (or equivalent experience) OR Master’s in Social Work (MSW)
• Active RN or LCSW/LMSW license in applicable state(s)
• 3–5 years of acute hospital case management leadership experience
• Hospital case management experience required
