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Utilization Review Management Jobs in Michigan (NOW HIRING)

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... This includes the implementation of case management scenarios, consulting with all services to ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... This includes the implementation of case management scenarios, consulting with all services to ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... This includes the implementation of case management scenarios, consulting with all services to ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Manage the full lifecycle of IRO cases from intake through final case closure. * Review incoming clinical documentation, verify completeness, and prepare concise case summaries for physician ...

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All JobsUtilization Review Management JobsUtilization Review Management Jobs in Michigan

Utilization Review Management information

See Michigan salary details

$13

$27

$46

How much do utilization review management jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization review management in Michigan is $27.84, according to ZipRecruiter salary data. Most workers in this role earn between $19.47 and $35.38 per hour, depending on experience, location, and employer.

What are the job titles for utilization review management?

Job titles in utilization review management include Utilization Review Nurse, Utilization Review Coordinator, Utilization Review Nurse Case Manager, and Utilization Review Supervisor. These roles typically involve assessing medical necessity, reviewing patient records, and ensuring compliance with healthcare policies, often requiring certification such as the Certified Professional in Healthcare Quality (CPHQ).

What is the difference between Utilization Review Management vs Utilization Review Nurse?

AspectUtilization Review ManagementUtilization Review Nurse
CredentialsTypically requires a healthcare management or related certification, sometimes a nursing backgroundRegistered Nurse (RN) license, often with additional utilization review certification
Work EnvironmentOffice-based, administrative setting, collaborating with healthcare providers and insurance companiesClinical setting, reviewing patient charts, and making utilization decisions
Employer & IndustryHealth insurance companies, managed care organizations, healthcare administratorsHospitals, insurance companies, healthcare facilities

Utilization Review Management professionals focus on overseeing review processes, policy compliance, and administrative tasks, while Utilization Review Nurses conduct clinical assessments to determine appropriate care. Both roles are essential in healthcare utilization management but differ in responsibilities and work environment.

What are some common challenges faced by professionals in utilization review management, and how can they be addressed?

Professionals in Utilization Review Management often encounter challenges such as balancing regulatory compliance with patient advocacy and managing high caseloads under tight deadlines. Navigating complex insurance policies and ensuring timely communication between healthcare providers and payers can be demanding. Staying organized, leveraging technology for workflow management, and participating in ongoing training can help address these challenges. Additionally, strong collaboration with interdisciplinary teams ensures more effective and efficient utilization review processes.

What is utilization review management?

Utilization Review Management is a process used in healthcare to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. Its primary goal is to ensure that patients receive appropriate care while preventing unnecessary or duplicative services. Utilization Review Management helps healthcare providers and insurance companies manage costs, maintain high-quality care, and comply with regulations. Professionals in this field often review patient records, coordinate with clinicians, and make recommendations about coverage or care plans.

What are the key skills and qualifications needed to thrive in utilization review management?

To thrive in Utilization Review Management, you need a solid background in healthcare, strong analytical skills, and often a clinical degree such as RN or LPN, with certification in utilization review or case management being highly beneficial. Familiarity with medical coding systems (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required. Excellent communication, critical thinking, and negotiation skills help you collaborate with providers and payers while advocating for patient care. These competencies are vital for ensuring appropriate resource use, regulatory compliance, and optimal patient outcomes.
Utilization Review Management jobs near you
Infographic showing various Utilization Review Management job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, and 4% Contract. Highlights an 91% Physical, 4% Hybrid, and 5% Remote job distribution, with an average salary of $57,905 per year, or $27.8 per hour.

Utilization Review Manager

Harbor Oaks Hospital

New Baltimore, MI • On-site

$25 - $35/hr

Full-time

Re-posted 23 days ago

Job description

Overview

Harbor Oaks Hospital is looking for a Utilization Review Manager to join our team!

Harbor Oaks Hospital, New Baltimore's leading Mental Health and Addiction Treatment Center is seeking a passionate Utilization Review Manager to work at our facility in New Baltimore, MI. 

Non-Exempt Position

Full Time Position

Monday - Friday - Day Shift 

Rate of Pay: $25.00 - $35.00 per hour (based on experience)

Responsibilities

PURPOSE STATEMENT:

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs. 

ESSENTIAL FUNCTIONS:

  • Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers.
  • Secure authorizations with insurance companies for inpatient treatment and continue to obtain authorizations for duration of patient stay.
  • Evaluate the utilization program for compliance with regulations, policies and procedures.
  • Review clinical documentation from denied stays against criteria to determine if documentation is adequate for requested treatment.
  • Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:

  • Perform other functions and tasks as assigned.
Qualifications

LICENSES/DESIGNATIONS/CERTIFICATIONS:

  • If applicable, current licensure as an LPN or RN or LPC, or LMSW or LLMSW within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
  • First aid may be required based on state or facility requirements.

HOAK01

#LI-HOH

Employment Type: FULL_TIME

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