Utilization Review Nurse
Troy, MI · On-site
... 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 ...
Troy, MI · On-site
... 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 ...
Troy, MI · On-site
... 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 ...
Troy, MI · On-site
... 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 ...
Troy, MI · On-site
... 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 ...
Troy, MI · On-site
$33 - $37/hr
Provider appeals and Utilization reviews and assist with Denial Letters * Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization ...
Troy, MI · On-site
$33 - $37/hr
Provider appeals and Utilization reviews and assist with Denial Letters * Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization ...
... 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 ...
... 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 ...
Troy, MI · Remote
$19/hr
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ... Generate correspondence and assist with faxing/mailing member and provider notifications * Complete ...
Quick apply
Troy, MI · Remote
$19/hr
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ... Generate correspondence and assist with faxing/mailing member and provider notifications * Complete ...
Troy, MI · On-site +1
$19/hr
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ... Generate correspondence and assist with faxing/mailing member and provider notifications * Complete ...
Troy, MI · On-site +1
$19/hr
Enter UM authorizations review requests in UM platform using ICD-10 and HCPCS codes * Verify ... Generate correspondence and assist with faxing/mailing member and provider notifications * Complete ...
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Detroit, MI · On-site
Perform Peer-to-Peer calls for inpatient and post-acute care denials * Assist with length of stay management and utilization of resources * Review and make suggestions related to resource and service ...
Dearborn Heights, MI · On-site
Monitors performance activities, including patient access and availability; utilization review and ... Attend local or out-of-town training opportunities or meetings as assigned. * Assist in the ...
Dearborn Heights, MI · On-site
Monitors performance activities, including patient access and availability; utilization review and ... Attend local or out-of-town training opportunities or meetings as assigned. * Assist in the ...
Troy, MI · On-site
... utilization * Communicate findings and trends to leadership * Participate in QAPI and quality improvement initiatives as needed * Conduct inter-rater reliability reviews when applicable * Assist with ...
New
Quick apply
Troy, MI · On-site
... utilization * Communicate findings and trends to leadership * Participate in QAPI and quality improvement initiatives as needed * Conduct inter-rater reliability reviews when applicable * Assist with ...
New
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
... expectations. Assist in meeting operational, financial, and patient satisfaction goals. Timely ... Improved timeliness of case reviews not meeting utilization management screening for inpatient ...
Troy, MI · On-site
$16/hr
... Assist with the pharmacy utilization review and reporting process Assist provider relations department with educating providers on the health plan's pharmacy process. Qualifications 3+ years of ...
Troy, MI · On-site
$16/hr
... Assist with the pharmacy utilization review and reporting process Assist provider relations department with educating providers on the health plan's pharmacy process. Qualifications 3+ years of ...
Identify inventory at risk of exceeding required turnaround times and assist with prioritization ... Apply knowledge of benefit determination, eligibility, authorization requirements, clinical review ...
New
Quick apply
Identify inventory at risk of exceeding required turnaround times and assist with prioritization ... Apply knowledge of benefit determination, eligibility, authorization requirements, clinical review ...
New
Troy, MI · On-site +1
$24/hr
Identify inventory at risk of exceeding required turnaround times and assist with prioritization ... Apply knowledge of benefit determination, eligibility, authorization requirements, clinical review ...
New
Troy, MI · On-site +1
$24/hr
Identify inventory at risk of exceeding required turnaround times and assist with prioritization ... Apply knowledge of benefit determination, eligibility, authorization requirements, clinical review ...
New
Ann Arbor, MI · On-site
$30 - $35/hr
Build a strong occupational therapy assistant program by participating in the following activates ... care, utilization review, case management, administrative staff / department head, and family ...
Ann Arbor, MI · On-site
$30 - $35/hr
Build a strong occupational therapy assistant program by participating in the following activates ... care, utilization review, case management, administrative staff / department head, and family ...
Build a strong occupational therapy assistant program by participating in the following activates ... care, utilization review, case management, administrative staff / department head, and family ...
Build a strong occupational therapy assistant program by participating in the following activates ... care, utilization review, case management, administrative staff / department head, and family ...
$10.44 - $15.19
14% of jobs
$17.62 is the 25th percentile. Wages below this are outliers.
$15.19 - $19.94
22% of jobs
$19.94 - $24.69
13% of jobs
The median wage is $25.24 / hr.
$24.69 - $29.44
14% of jobs
$29.44 - $34.18
11% of jobs
$35.37 is the 75th percentile. Wages above this are outliers.
$34.18 - $38.93
9% of jobs
$38.93 - $43.68
7% of jobs
$43.68 - $48.43
4% of jobs
$48.43 - $53.17
3% of jobs
$53.17 - $57.92
2% of jobs
$57.92 - $62.67
1% of jobs
$10
$30
$62
A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.
To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.
A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.
The most popular types of Utilization Review jobs in Detroit, MI are:
For Utilization Review Assistant jobs in Detroit, MI, the most frequently searched job titles are:
The top searched job categories for Utilization Review Assistant jobs in Detroit, MI are:
Cities near Detroit, MI with the most Utilization Review Assistant job openings:

Contractor
Re-posted 18 days ago
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!
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.
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.
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!
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.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003