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Utilization Review Case Manager Jobs in Michigan

Trinity Health

Case Management

Livonia, MI · On-site

Five years of clinical experience in nursing and recent (within 2 year) experience in utilization review/management/discharge planning or case management. • Current knowledge of third party payor ...

TEEMA

Case Manager

Detroit, MI · On-site

$58 - $60/hr

MANAGER IS VERY STRICT ON THE RECENT INPATIENT CASE MANAGEMENT EXPERIENCE - TELEPHONIC, UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.

TEEMA

Case Manager

Detroit, MI · On-site

$55 - $60/hr

MANAGER IS VERY STRICT ON THE RECENT INPATIENT CASE MANAGEMENT EXPERIENCE - TELEPHONIC, UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.

Memorial Healthcare

RN Case Manager

Owosso, MI · On-site

Prior Case Management or utilization review experience preferred. Case Management certification preferred. Essential Physical Requirements Must be able to sit or stand for long periods of time; be ...

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Utilization Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review case manager in Michigan is $31.80, according to ZipRecruiter salary data. Most workers in this role earn between $25.77 and $33.51 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Review Case Manager jobs in Michigan?

For Utilization Review Case Manager jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Michigan look for?

The top searched job categories for Utilization Review Case Manager jobs in Michigan are:

What cities in Michigan are hiring for Utilization Review Case Manager jobs?

Cities in Michigan with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Michigan as of August 2026, with employment types broken down into 57% Full Time, and 43% Contract. Highlights an 100% In-person job distribution, with an average salary of $66,146 per year, or $31.8 per hour.

Registered Nurse Case Manager - Contingent - 5 years CM required.

Henry Ford Health System

Detroit, MI • On-site

Full-time

Re-posted 4 days ago

Henry Ford Health rating

6.9

Company rating: 6.9 out of 10

Based on 572 frontline employees who took The Breakroom Quiz

455th of 898 rated healthcare providers

Job description

5-years RN Case Management experience required.
Contingent
Shift: Days
GENERAL SUMMARY:
The Case Manager-RN plays a pivotal role in coordinating comprehensive patient care, ensuring seamless transitions between care levels. This position requires strong clinical judgment, excellent communication skills, and a deep understanding of healthcare systems. The Case Manager-RN will collaborate closely with patients, families, healthcare providers, and community resources to optimize patient outcomes and promote efficient resource utilization.
Orientation:
Monday through Friday 8 - 4:30 pm for 6 weeks and within those six weeks the new hire will need one weekend orientation consisting of onsite Sat/Sun 7:30-4pm. The new hire will get one day off during the week before Saturday worked, and one day off during the week after for the Sunday worked.
Key Responsibilities:
Clinical Care Coordination:
  • Conduct comprehensive patient assessments to identify individualized needs and develop personalized care plans.
  • Collaborate with the healthcare team to ensure timely and appropriate interventions, including specialty consultations and referrals.
  • Monitor patient progress, identify potential barriers to care, and implement strategies to address them proactively.
  • Facilitate patient education and support to empower patients and families in their healthcare decisions.

Discharge Planning:
  • Develop and implement comprehensive discharge plans that address the patient's physical, social, and financial needs.
  • Coordinate with community resources and post-acute care providers to ensure a smooth transition of care.
  • Advocate for patients' rights and ensure access to necessary services and support.

Quality Improvement:
  • Analyze patient outcomes and identify opportunities for improvement in care processes.
  • Participate in quality improvement initiatives and contribute to the development of best practices.
  • Stay updated on relevant regulations, guidelines, and industry trends to ensure compliance and optimize care delivery.

Interdisciplinary Collaboration:
  • Collaborate effectively with physicians, nurses, social workers, therapists, and other healthcare professionals to deliver coordinated care.
  • Facilitate communication and information sharing among team members to ensure optimal patient outcomes.
  • Build strong relationships with community partners to support patient needs beyond the hospital setting.

Qualifications:
  • Registered Nurse (RN) with active licensure
  • Minimum [number] years of clinical experience in [relevant specialty]
  • Strong organizational and time management skills
  • Excellent communication and interpersonal skills
  • Proficiency in electronic health records (EHR)
  • Knowledge of case management principles and practices
  • Ability to work independently and as part of a team

Additional Skills (Preferred):
  • Certification in Case Management (CCM)
  • Experience in discharge planning or transitional care
  • Knowledge of Medicare, Medicaid, and other insurance programs

By joining our team as a Case Manager-RN, you will have the opportunity to make a significant impact on the lives of patients and their families. Your expertise in clinical care, discharge planning, and quality improvement will be instrumental in ensuring that patients receive the highest quality care possible.
EDUCATION/EXPERIENCE REQUIRED:
  • Bachelor's degree in Nursing (BSN) is preferred.
  • Associate's degree in Nursing (ADN) with at least two years of acute care case management experience is acceptable.
  • ADN candidates must enroll in an accredited BSN program within three years of hire and complete it within five years.
  • Minimum of three years of recent acute care nursing experience.
  • Prior case management experience is highly preferred.

Certifications:
  • Certification in Case Management (CCM) by the Commission for Case Management Certification or Accredited Case Manager (ACM) by the American Case Management Association is required within one year of hire.

Certifications:
  • Certification in Case Management (CCM) by the Commission for Case Management Certification or Accredited Case Manager (ACM) by the American Case Management Association is required within one year of hire.

Knowledge and Skills:
  • Strong clinical knowledge and understanding of medical literature and research methodology.
  • Familiarity with financial and reimbursement issues in healthcare.
  • Excellent communication and interpersonal skills, including the ability to collaborate effectively with diverse teams.
  • Strong organizational and time management skills.
  • Proficiency with computers, electronic health records (EHR), database systems, and utilization review/case management documentation systems.
  • Knowledge of CMS, commercial payer requirements, and hospital financial/reimbursement processes is desirable.
  • Demonstrated ability to think critically, solve problems creatively, and plan effectively.
  • Self-direction, flexibility, and the ability to work in a fast-paced environment.

Licenses and Certifications:
  • Registered Nurse (RN) with a valid, unrestricted State of Michigan license.
  • Adherence to Henry Ford Health's Customer Service Policy and standards.

Personal Qualities:
  • Self-direction and commitment to teamwork.
  • Initiative and willingness to learn.
  • Openness to new experiences and respect for diversity.
  • Demonstrated customer service values.

What Henry Ford Health employees say

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About Henry Ford Health

Sourced by ZipRecruiter

Henry Ford Health provides a full continuum of services from Primary and Preventative care, to Complex and Cpecialty care, Health Insurance, a full suite of home health offerings, Virtual care, Pharmacy, Eye care and other Healthcare retail. It is one of the Nation’s leading Academic Medical Centers, recognized for Clinical excellence in Cancer care, Cardiology and Cardiovascular Surgery, Neurology and Neurosurgery, Orthopedics and Sports medicine, and Multi organ transplants. Consistently ranked among the top five NIH funded institutions in Michigan, Henry Ford Health engages in more than 2,000 research projects annually. Equally committed to educating the next generation of Health Professionals, Henry Ford Health trains more than 4,000 Medical students, Residents and fellows every year across 50+ accredited programs. With more than 33,000 valued team members, Henry Ford Health is also among Michigan’s largest and most Diverse employers, including nearly 6,000 physicians and researchers from the Henry Ford Medical Group, Henry Ford Physician Network and Jackson Health Network.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Detroit, MI, US

Year founded

1915

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