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Utilization Manager Jobs in Brighton, MI (NOW HIRING)

OpTech LLC

RN Utilization Management

Detroit, MI · On-site

Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan. Perform prospective, concurrent and retrospective review ...

Spectrum Health

Utilization Mgmt Spec

Southfield, MI · On-site

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 ...

Corewell Health

Utilization Mgmt Spec

Southfield, MI · On-site

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 ...

KYYBA

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 ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Manage the full lifecycle of IRO cases from intake through final case closure. * Review incoming ...

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 ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Brighton, MI

Utilization Manager information

See Brighton, MI salary details

$37.4K

$87.3K

$160.7K

How much do utilization manager jobs pay per year?

As of Sep 7, 2026, the average yearly pay for utilization manager in Brighton, MI is $87,316.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,100.00 and $105,100.00 per year, depending on experience, location, and employer.

What is a utilization manager?

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.

What are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound 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.

More about Utilization Manager jobs

What job categories do people searching Utilization Manager jobs in Brighton, MI look for?

The top searched job categories for Utilization Manager jobs in Brighton, MI are:

What cities near Brighton, MI are hiring for Utilization Manager jobs?

Cities near Brighton, MI with the most Utilization Manager job openings:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Brighton, MI as of August 2026, with employment types broken down into 84% Full Time, 14% Part Time, and 2% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $87,316 per year, or $42 per hour.

RN Utilization Management

OpTech LLC

Detroit, MI • On-site

Full-time

Retirement

Posted 19 days ago

Job description

Detroit, Michigan
Registered Nurse (RN)
Contract
We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan.
Job Description:
Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. May establish care plans and coordinate care through the health care continuum including member outreach assessments.
EDUCATION AND EXPERIENCE:
  • Registered Nurse unrestricted/current Michigan RN license
  • 2 + yr clinical experience - acute care
  • Utilization Management experience/role
  • Technical - MS Office, Type 35+ WPM, Dual monitors, multiple systems
  • 1 yr health insurance plan experience or managed care environment preferred .
  • Bachelor's degree in nursing, allied health, business, or related field preferred .
  • Certification in Case Management preferred

ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Review, research and authorize requests for authorization of elective, direct, ancillary, urgent, emergency, etc. services. Contact appropriate medical and support personnel to identify and recommend alternative treatment, service levels, length of stays, etc. using approved clinical protocols.
2. Analyze, research, respond to and prepare documentation related to retrospective review requests and appeals in accordance with local, state and federal regulatory and designated accreditation (e.g. NCQA) standards.
3. Establish, coordinate and communicate discharge planning needs with appropriate internal and external entities.
4. Analyze patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels.
5. Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, Mental Health, Substance Abuse care coordination, etc.
6. Identify and document quality of care issues; resolve or route to appropriate area for resolution.
7. Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care.
8. Develop and deliver targeted education for provider community related to policies, procedures, benefits, etc.
9. As needed and in conjunction with Provider Services, may identify and negotiate reimbursement rates for non-contracted providers for services.
10. Other duties may be assigned based on designated department assignment.
Why work with us? We are a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work with us you'll have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! We are an EOE, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. https://www.optechus.com/eeo_self_identification/

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