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Utilization Management Jobs in Rochester Hills, MI

KYYBA

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Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Minimum 5 years of healthcare experience . * 3-5 years of Utilization Management experience required. * Experience with InterQual and/or MCG criteria . * Knowledge of CMS, NCQA, HIPAA, PA60 ...

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 ...

TH Medical

Director - Case Management

Detroit, MI · On-site

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

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Utilization Management information

See Rochester Hills, MI salary details

$35.9K

$82.4K

$150K

How much do utilization management jobs pay per year?

As of Aug 25, 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 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 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 degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

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:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Rochester Hills, MI as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $82,364 per year, or $39.6 per hour.

Remote Utilization Review RN

Detroit, MI • Remote

KYYBA
Recruiting and Staffing Services • 501 - 1,000 employees
Learn more about KYYBAexternal

$35 - $39/hr

Contractor

Medical, Dental, Vision, PTO

Posted 15 days ago

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Job description

Job Title: Utilization Review RN
Contract Duration: 12+ months
Job Location: 100% REMOTE
License Requirements: MI Registered Nurse License

Mandatory Requirements to Apply

  • Active, unrestricted Michigan Registered Nurse (RN) license required.
  • Nursing Diploma or Associate Degree in Nursing required; BSN preferred.
  • Minimum 5 years of healthcare experience.
  • 3–5 years of Utilization Management experience required.
  • Experience with InterQual and/or MCG criteria.
  • Knowledge of CMS, NCQA, HIPAA, PA60, utilization management, and clinical documentation.
  • Working knowledge of ICD-10 and CPT coding.

Roles & Responsibilities

  • Deliver clinical education and training for Care Management and Utilization Management staff, including onboarding, mentoring, and ongoing professional development.
  • Conduct quality reviews, internal and external audits, and analyze performance to support accreditation and continuous quality improvement initiatives.
  • Develop, maintain, and update training materials, manuals, and educational resources reflecting system updates, InterQual criteria, and departmental processes.
  • Collaborate with leadership and subject matter experts to implement new programs, systems, and process improvements while supporting change management initiatives.
  • Coordinate training operations, including scheduling, class administration, new hire system access, attendance tracking, and communication with internal teams and external provider facilities.

Salary & Benefits

  • Pay: $35–$39 per hour
  • Health Insurance (Medical, Dental and Vision)
  • 9 Days of Paid Time Off
  • All equipment provided by the client

Company Description

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

KYYBA logo

About KYYBA

Sourced by ZipRecruiter

About Kyyba: Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Industry

Recruiting and staffing services

Company size

501 - 1,000 Employees

Headquarters location

Farmington Hills, MI, US

Year founded

1998

Social media

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