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Utilization Review Rn Jobs in Detroit, MI (NOW HIRING)

Corewell Health

RN Care Coordinator

Detroit, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with ...

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with ...

Corewell Health

RN Care Coordinator

Royal Oak, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Preferred Will consider non-BSN RN if actively pursuing a bachelor's degree in nursing with ...

Spectrum Health

RN Care Coordinator

Dearborn, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with ...

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination ... Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with ...

ICONMA

Registered Nurse-Review Analys

Detroit, MI · On-site

Our client, a Health Insurance company, is looking for a Registered Nurse-Review Analyst for their ... One (1) year of utilization management preferred. * Certification in Case Management may be ...

P.I.E. Management

Registered Nurse (RN)

Detroit, MI · On-site

$64/hr

Registered Nurse (RN) Location: Detroit, MI (In-Person) Pay Rate: $64.00 per hour Employment Type ... Experience in case management, care coordination, utilization review, or discharge planning is ...

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Utilization Review Rn information

See Detroit, MI salary details

$19

$38

$63

How much do utilization review rn jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review rn in Detroit, MI is $38.69, according to ZipRecruiter salary data. Most workers in this role earn between $30.58 and $44.42 per hour, depending on experience, location, and employer.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Detroit, MI?

The most popular types of Utilization Review Rn jobs in Detroit, MI are:

What are popular job titles related to Utilization Review Rn jobs in Detroit, MI?

For Utilization Review Rn jobs in Detroit, MI, the most frequently searched job titles are:

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The top searched job categories for Utilization Review Rn jobs in Detroit, MI are:

What cities near Detroit, MI are hiring for Utilization Review Rn jobs?

Cities near Detroit, MI with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Detroit, MI as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $80,470 per year, or $38.7 per hour.

RN Care Coordinator

Spectrum Health

Farmington Hills, MI

Part-time

Medical, Retirement

Posted 26 days ago

Job description

PART TIME- 20 hours a week.

Scope of work
Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.
  • Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).
  • Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs.
  • Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.
  • May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff.
  • Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.
  • Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations.
  • Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately.
  • Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.
Qualifications
  • Required Bachelor's Degree Graduate of an accredited school of nursing.
  • Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire.
  • 2 years of relevant experience Minimum two years' experience in the acute care setting. Required
  • 3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred
  • Registered Nurse (RN) - State of Michigan Upon Hire required
  • CRT-At least one Certification from preferred list - UNKNOWN Unknown Upon Hire required
  • Basic Life Support (BLS) - AHA American Heart Association preferred Or
  • Basic Life Support (BLS) - ARC American Red Cross preferred
  • Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

    How Corewell Health cares for you
    • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
    • On-demand pay program powered by Payactiv
    • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
    • Optional identity theft protection, home and auto insurance
    • Traditional and Roth retirement options with service contribution and match savings
    • Eligibility for benefits is determined by employment type and status

    Primary Location

    SITE - Farmington Hills Hospital- 28050 Grand River Ave - Farmington Hills

    Department Name

    Care Management - Farmington Hills Hosp

    Employment Type

    Part time

    Shift

    Day (United States of America)

    Weekly Scheduled Hours

    20

    Hours of Work

    8:00am to 4:30pm

    Days Worked

    Variable

    Weekend Frequency

    Variable weekends

    CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

    Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

    Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

    An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

    You may request assistance in completing the application process by calling 616.486.7447.

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