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 ...
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 ...
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 ...
Registered Nurse Looking for Utilization Management AND Education experience. Scope of work: In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral ...
Registered Nurse Looking for Utilization Management AND Education experience. Scope of work: In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral ...
Registered Nurse Looking for Utilization Management AND Education experience. Scope of work: In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral ...
Registered Nurse Looking for Utilization Management AND Education experience. Scope of work: In conjunction with Medical Management leadership, coordinates the educational plan for the Behavioral ...
Hastings, MI · On-site
$58K/yr
We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ...
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Hastings, MI · On-site
$58K/yr
We are seeking a detail-oriented and clinically skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible for reviewing behavioral health services to ...
Troy, MI · On-site +1
$160K - $160K/yr
Integra's Utilization Management (UM) division is looking for an experienced individual to direct the clinical and non-clinical utilization management teams for a managed care organization. This ...
Troy, MI · On-site +1
$160K - $160K/yr
Integra's Utilization Management (UM) division is looking for an experienced individual to direct the clinical and non-clinical utilization management teams for a managed care organization. This ...
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 ...
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 ...
Lansing, MI · On-site
UTILIZATION MANAGEMENT CLERK BENEFITS PACKAGE: Holiday Pay : New Year's Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran's Day, Thanksgiving Day, and ...
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Lansing, MI · On-site
UTILIZATION MANAGEMENT CLERK BENEFITS PACKAGE: Holiday Pay : New Year's Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran's Day, Thanksgiving Day, and ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. * Collaborates with the ...
Troy, MI · On-site
$56.17 - $70.21/hr
Apply evidence-based utilization management criteria and clinical protocols to establish continued stay review intervals and determine authorization status. * Document clinical reviews, authorization ...
Troy, MI · On-site
$56.17 - $70.21/hr
Apply evidence-based utilization management criteria and clinical protocols to establish continued stay review intervals and determine authorization status. * Document clinical reviews, authorization ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care ...
Assists with utilization management reporting, data collection, and performance improvement initiatives as requested. 12. Demonstrates service excellence by providing complete clinical information to ...
Assists with utilization management reporting, data collection, and performance improvement initiatives as requested. 12. Demonstrates service excellence by providing complete clinical information to ...
Assists with utilization management reporting, data collection, and performance improvement initiatives as requested. 12. Demonstrates service excellence by providing complete clinical information to ...
Assists with utilization management reporting, data collection, and performance improvement initiatives as requested. 12. Demonstrates service excellence by providing complete clinical information to ...
Bay City, MI · On-site
$65 - $90/hr
Works collaboratively with case management to expedite patient discharge. * Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective ...
Bay City, MI · On-site
$65 - $90/hr
Works collaboratively with case management to expedite patient discharge. * Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective ...
Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...
Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...
Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...
Direct and manage the day-to-day operations of the Utilization Review department. Responsibilities ESSENTIAL FUNCTIONS: * Monitor utilization of services and optimize reimbursement for the facility ...
Hospital utilization review/utilization management experience. Preferred * Clinical appeals experience. Preferred * Registered Nurse (RN) - State of Michigan Upon Hire required How Corewell Health ...
Hospital utilization review/utilization management experience. Preferred * Clinical appeals experience. Preferred * Registered Nurse (RN) - State of Michigan Upon Hire required How Corewell Health ...
$34K - $44.2K
9% of jobs
$51.7K is the 25th percentile. Wages below this are outliers.
$44.2K - $54.4K
22% of jobs
$54.4K - $64.5K
11% of jobs
The median wage is $70.8K / yr.
$64.5K - $74.7K
14% of jobs
$74.7K - $84.9K
12% of jobs
$91.3K is the 75th percentile. Wages above this are outliers.
$84.9K - $95.1K
13% of jobs
$95.1K - $105.3K
13% of jobs
$105.3K - $115.4K
5% of jobs
$115.4K - $125.6K
2% of jobs
$125.6K - $135.8K
0% of jobs
$135.8K - $146K
0% of jobs
$34K
$79.3K
$146K
A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.
| Aspect | Utilization Manager | Utilization Coordinator |
|---|---|---|
| Certifications | Often requires healthcare or case management certifications | May have similar certifications but less emphasis on management |
| Work Environment | Typically in healthcare organizations, overseeing utilization review processes | Supports daily operations, assisting with case documentation and scheduling |
| Employer & Industry Usage | Common in healthcare, insurance, and managed care companies | Found in similar settings, often working under Utilization Managers |
In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.
The most popular types of Utilization jobs in Michigan are:
For Utilization Manager jobs in Michigan, the most frequently searched job titles are:
The top searched job categories for Utilization Manager jobs in Michigan are:
Cities in Michigan with the most Utilization Manager job openings:
For Utilization Manager jobs in MI, the most frequently searched job titles are:

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!
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.
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.
Are you an experienced RN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career In Nursing by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN position for you!
If you are interested, reach out to me (Krishna) at 321-574-6926
The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!
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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.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003