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Utilization Review Management Jobs in Michigan (NOW HIRING)

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 ...

Corewell Health

Utilization Mgmt Spec

Climax, 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 ...

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 ...

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Showing results 21-40

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.

Behavioral Health Utilization Management Specialist

Barry County Community Mental Health Aut

Hastings, MI • On-site

$58K/yr

Full-time

Re-posted 4 days ago

Job description

Location: Primarily Remote (Michigan-based)
Schedule: Full-Time | Option for Four-Day Work Week

Position Overview:
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 ensure medical necessity, regulatory compliance, and appropriate level of care determinations. The ideal candidate brings strong clinical judgment, experience with managed care or utilization management processes, familiarity with Community Mental Health/CMHSP operations, and the ability to work independently in a remote environment.

Key Responsibilities:

  • Conduct utilization reviews for behavioral health services, including initial, concurrent, and retrospective reviews
  • Assess clinical documentation to determine medical necessity and appropriate level of care
  • Ensure compliance with state, federal, and payer-specific regulations and guidelines
  • Collaborate with providers, care teams, and internal stakeholders to support quality service delivery
  • Maintain accurate and timely documentation of all UM activities
  • Participate in audits, quality improvement initiatives, and process enhancements
  • Stay current on best practices, regulatory updates, and industry standards in behavioral health and managed care

Qualifications:

  • Master’s degree in Social Work, Professional Counseling, Psychology, or a related behavioral health field
  • Current, active licensure in the State of Michigan (e.g., LMSW/LLMSW, LPC/LLPC, LLP/TLLP)
  • Prior experience in utilization management, managed care, or similar review functions required
  • Strong attention to detail and critical thinking skills
  • Excellent written and verbal communication abilities
  • Ability to work independently while managing multiple priorities

Preferred Qualifications:

  • Experience with behavioral health payer guidelines and authorization processes
  • Familiarity with electronic health records and UM software systems

What We Offer:

  • Four-day work week promoting work-life balance
  • Primarily remote work environment with flexible scheduling
  • Collaborative and mission-driven team culture
  • Opportunities for professional growth and development

How to Apply:
Interested candidates should submit a resume and cover letter outlining their relevant experience and licensure status.

We are an equal opportunity employer committed to diversity, equity, and inclusion in the workplace.