Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with ...
Required * Hospital utilization review/utilization management experience. Preferred * Clinical appeals experience. Preferred * LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire ...
Required * Hospital utilization review/utilization management experience. Preferred * Clinical appeals experience. Preferred * LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire ...
Utilization Management Clinical Analyst HYBRID (PCN 1534)
Troy, MI · On-site
$56K - $70K/yr
Job Summary The Utilization Management Clinical Analyst conducts prospective reviews of authorization requests to determine medical necessity and clinical appropriateness of behavioral health ...
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Utilization Management Clinical Analyst HYBRID (PCN 1534)
Troy, MI · On-site
$56K - $70K/yr
Job Summary The Utilization Management Clinical Analyst conducts prospective reviews of authorization requests to determine medical necessity and clinical appropriateness of behavioral health ...
Utilization Management Clinical Analyst - SUD HYBRID (PCN 1543)
Troy, MI · On-site
$56K - $70K/yr
Job Summary The Utilization Management Clinical Analyst - Substance Use Disorder (SUD) conducts prospective and concurrent reviews of substance use disorder authorization requests to determine ...
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Utilization Management Clinical Analyst - SUD HYBRID (PCN 1543)
Troy, MI · On-site
$56K - $70K/yr
Job Summary The Utilization Management Clinical Analyst - Substance Use Disorder (SUD) conducts prospective and concurrent reviews of substance use disorder authorization requests to determine ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Senior Utilization Management Compliance and Accreditation Specialist Number of Positions: 1 Location: Okemos, MI Location Specifics: Hybrid Position Job Summary: At Delta Dental of Michigan, Ohio ...
Senior Utilization Management Compliance and Accreditation Specialist Number of Positions: 1 Location: Okemos, MI Location Specifics: Hybrid Position Job Summary: At Delta Dental of Michigan, Ohio ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
RN Utilization Review Nurse
$33 - $37/hr
Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare. * Works with the Utilization Management team primarily responsible for inpatient medical necessity ...
RN Utilization Review Nurse
$33 - $37/hr
Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare. * Works with the Utilization Management team primarily responsible for inpatient medical necessity ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor ...
Utilization Review Supervisor (PCN 1547)
Troy, MI · On-site
$70K - $87K/yr
The position also participates in management meetings, workgroups, and strategic initiatives while ... Supervise and evaluate Utilization Review (UR) and Acute Care Authorization staff to ensure ...
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Utilization Review Supervisor (PCN 1547)
Troy, MI · On-site
$70K - $87K/yr
The position also participates in management meetings, workgroups, and strategic initiatives while ... Supervise and evaluate Utilization Review (UR) and Acute Care Authorization staff to ensure ...
Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required. Additional Information
Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required. Additional Information
Utilization Review Analyst HYBRID (PCN 1542)
Troy, MI · On-site
$56K - $70K/yr
Apply evidence-based utilization management criteria and clinical protocols to establish continued stay review intervals and determine authorization status. * Document clinical reviews, authorization ...
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Utilization Review Analyst HYBRID (PCN 1542)
Troy, MI · On-site
$56K - $70K/yr
Apply evidence-based utilization management criteria and clinical protocols to establish continued stay review intervals and determine authorization status. * Document clinical reviews, authorization ...
Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required.
Previous utilization management or case management experience preferred. CERTIFICATIONS/LICENSURES REQUIRED: * RHIT, RHIA, or related coding certification required.
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare ...
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
Utilization Management information
See Rochester Hills, MI salary details
$35.9K - $46.3K
15% of jobs
$46.3K - $56.6K
8% of jobs
$58.1K is the 25th percentile. Wages below this are outliers.
$56.6K - $67K
15% of jobs
The median wage is $73.6K / yr.
$67K - $77.4K
20% of jobs
$77.4K - $87.8K
11% of jobs
$93K is the 75th percentile. Wages above this are outliers.
$87.8K - $98.2K
13% of jobs
$98.2K - $108.5K
5% of jobs
$108.5K - $118.9K
3% of jobs
$118.9K - $129.3K
4% of jobs
$129.3K - $139.7K
3% of jobs
$139.7K - $150K
3% of jobs
$35.9K
$82.4K
$150K
How much do utilization management jobs pay per year?
What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 a Utilization Management job?
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.

Part-time
Medical, Vision, Retirement
Posted 11 days ago
Corewell Health rating
6.9
Based on 771 frontline employees who took The Breakroom Quiz
455th of 890 rated healthcare providers
Job description
Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement.
Essential Functions
- Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment.
- Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status.
- Utilizes electronic medical record work queues that support Utilization Management functions.
- Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
- Problem solves issues that are received via phone, fax or email.
- Other duties as assigned.
Qualifications
Required
- High School Diploma or equivalent
Preferred
- 2 years of relevant experience healthcare experience
- Preferred Post high school training and/or academic coursework leading toward associate's or bachelor's degree.
About Corewell Health
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
How Corewell Health cares for you
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd
Department Name
Utilization Management - Diversified East WB Mkt
Employment Type
Part time
Shift
Day (United States of America)
Weekly Scheduled Hours
8
Hours of Work
8:00 a.m. - 4:30 p.m.
Days Worked
Monday - Friday
Weekend Frequency
N/A
CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
What Corewell Health employees say
Pay
Benefits
Hours and flexibility
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About Corewell Health
Sourced by ZipRecruiter
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Grand Rapids, MI, US