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

RN Field Case Manager

Pontiac, MI

$77K - $98K/yr

WHY BE PRN RN WITH HOPE AT HOME... * Unlimited earning potential!!! * Provide care in Oakland ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their ... Participates in utilization review of medical records as assigned. 19. Gives total patient care as ...

RN Field Case Manager

Troy, MI · On-site

$100K/yr

WHY BE A RN FIELD CASE MANAGER WITH HOPE AT HOME... * Earn upwards of $100k per year (based on ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

RN Field Case Manager

Troy, MI · On-site

$100K/yr

WHY BE A RN FIELD CASE MANAGER WITH HOPE AT HOME... * Earn upwards of $100k per year (based on ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

RN Field Case Manager

Oxford, MI · On-site

$100K/yr

WHY BE A RN FIELD CASE MANAGER WITH HOPE AT HOME... * Earn upwards of $100k per year (based on ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

Showing results 41-60

Utilization Review Rn information

See Macomb, MI salary details

$20

$40

$66

How much do utilization review rn jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review rn in Macomb, MI is $40.92, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $46.97 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 popular job titles related to Utilization Review Rn jobs in Macomb, MI?

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

What job categories do people searching Utilization Review Rn jobs in Macomb, MI look for?

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

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

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

Infographic showing various Utilization Review Rn job openings in Macomb, 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 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $85,106 per year, or $40.9 per hour.

$77K - $98K/yr

Per diem

Re-posted 15 days ago


Job description

We are looking for a compassionate RN to join our growing team! The right candidate has a can-do attitude, a friendly demeanor, excellent interpersonal skills, and the ability to provide medical support to our clients in their homes.

WHY BE PRN RN WITH HOPE AT HOME...

  • Unlimited earning potential!!!
  • Provide care in Oakland, Wayne, Macomb, Washtenaw, Livingston, and Genessee counties
  • Flexible schedules (work days, nights, evenings, weekends - we'll work around your needs)!!!

So become a part of the Hope At Home Family and apply TODAY (serious applicants only)!

We currently have a position available for an experienced Home Health Care Registered Nurse! An RN with PICC Line, Wound Care, and Infusion experience is greatly preferred.

The corporate office is located in Southfield, MI and the individual will provide RN support throughout our service areas:

  • Oakland, Wayne, Macomb, Washtenaw, Livingston, and Genessee counties

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Clinical Manager/Nursing Supervisor.

QUALIFICATIONS:

  • Graduate of an approved school of professional nursing and currently licensed in the state of Michigan
  • One year of nursing experience
  • Kinnser - EMR experience preferred
  • Home Healthcare experience preferred
  • Experience in wound vac, PICC line and mediport care, preferred
  • Pediatric experience, desired

RESPONSIBILITIES:

  • Provides services in accordance with the plan of care.
  • Makes the initial evaluation visit and regularly reevaluates the patient's nursing needs.
  • Initiates the plan of care and necessary revisions.
  • Provides those services requiring substantial specialized nursing skills.
  • Initiates appropriate preventive and rehabilitative nursing procedures.
  • Prepares clinical and progress notes for each patient visit and summaries of care conferences on his/her patients in a timely manner as per Agency policy.
  • Coordinates services.
  • Inform personnel of changes in the condition and needs of the patient.
  • Counsels the patient and family/significant others in meeting nursing and related needs.
  • Participates in and presents in-service programs.
  • Understands and adheres to established Agency policies and procedures.
  • Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries.
  • Determines the amount and type of nursing needed by each individual patient.
  • Refers to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Medical Social Worker those patients requiring their specialized skills.
  • Supervises and teaches other nursing personnel.
  • Conducts patient care conferences on patients assigned to his/her care.
  • Participates in peer review and performance improvement as assigned.
  • Participates in utilization review of medical records as assigned.
  • Gives total patient care as needed.
  • Takes on-call duty nights, weekends and holidays, as assigned.
  • Completes and submits OASIS assessments, reassessments, transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames.
  • Appropriately utilizes ICD-10 codes.

WORKING ENVIRONMENT:
Works indoors in Agency office and patient homes and travels to/from patient homes.

HOPE At Home Health Care is a full service home care agency dedicated to helping people excel in the comfort of their home. We offer Medicare certified skilled services. Whether you are recovering from injury or illness, or simply want to reinvigorate your mobility and health, HOPE At Home Health Care has a solution for you.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.