Utilization Review Nurse
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 Molina Healthcare ...
Utilization Review Nurse
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 Molina Healthcare ...
Utilization Review- RN
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 Molina Healthcare ...
Utilization Review- RN
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 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 ...
RN Utilization Review Nurse
Troy, MI · On-site
$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
Troy, MI · On-site
$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 ...
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 Manager
New Baltimore, MI · On-site
$25 - $35/hr
Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor Oaks ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor Oaks ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
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.
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
Utilization Review Manager
New Baltimore, MI · On-site
$25 - $35/hr
Overview Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team! Harbor ... Provide staff management to including hiring, development, training, performance management and ...
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 ...
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 ...
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 ...
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.
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.
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 Clinical Analyst HYBRID (PCN 1543)
Troy, MI · On-site
$56K - $70K/yr
Analyze data and management reports. Provide recommendations for improvement plans as well as recognition for exemplary practices. * Participate in workgroups and committees with other OCHN Teams ...
Quick apply
Apply Early
Utilization Management Clinical Analyst HYBRID (PCN 1543)
Troy, MI · On-site
$56K - $70K/yr
Analyze data and management reports. Provide recommendations for improvement plans as well as recognition for exemplary practices. * Participate in workgroups and committees with other OCHN Teams ...
Apply Early
Director Case Management
Detroit, MI · On-site
$103K - $155K/yr
... hospital utilization management, transition management, care coordination, and operational ... leadership within a high-volume acute care hospital setting. This role is responsible for driving ...
Quick apply
Apply Early
Director Case Management
Detroit, MI · On-site
$103K - $155K/yr
... hospital utilization management, transition management, care coordination, and operational ... leadership within a high-volume acute care hospital setting. This role is responsible for driving ...
Apply Early
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?
As of Jul 6, 2026, the average yearly pay for utilization management in Rochester Hills, MI is $82,364.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,400.00 and $96,200.00 per year, depending on experience, location, and employer.
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.
What are popular job titles related to Utilization Management jobs in Rochester Hills, MI? For Utilization Management jobs in Rochester Hills, MI, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Rochester Hills, MI look for? The top searched job categories for Utilization Management jobs in Rochester Hills, MI are:
What cities near Rochester Hills, MI are hiring for Utilization Management jobs? Cities near Rochester Hills, MI with the most Utilization Management job openings:
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Company: Molina Healthcare
Location: 880 Long Lake Rd Suite 600 Troy, Michigan 48098
Shift: Daytime hours
Employment: Contract: 1-2 months (possibility of going longer depending on business needs)
Company Job Description/Day to Day Duties:
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provider appeals and Utilization reviews and assist with Denial Letters
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
Qualifications
Minimum Education/Qualifications/Licensures:
Must be an RN
Utilization Review background in either Managed Care of Provider environment (at least one year)
Interqual experience
Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
Additional Information
Apply now for immediate consideration. After applying, a recruiting consultant will contact you for pre-screening. Please provide your best phone number to contact.
Thanks and look forward to hearing from you!
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003