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Utilization Review Social Worker Jobs in Michigan

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... working with vulnerable populations, such as, minors, elderly and those with physical or mental ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Utilization Review Manager

Grand Rapids, MI

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Utilization Review Manager

Grand Rapids, MI

... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

UHS

Manager of Utilization Review

Saint Johns, MI · On-site

Cedar Creek Hospital Description The Manager of Utilization Review is responsible for managing and ... g., Social Security Number, credit card or bank information, etc.) from you via email. Our ...

Lifepoint Health

Social Worker (LSW)

Detroit, MI · On-site

As a Social Worker (LSW) joining our team, you're embracing a vital mission dedicated to making ... Utilization Review (Insurance Authorization), Clinical Coordinator and team leads. How you'll ...

Lifepoint Health

Social Worker (LSW)

Detroit, MI

As a Social Worker (LSW) joining our team, you're embracing a vital mission dedicated to making ... Utilization Review (Insurance Authorization), Clinical Coordinator and team leads. How you'll ...

MyMichigan Health

Social Worker MSW

Alpena, MI · On-site

... utilization review to patients hospitalized on the mental health unit. This role is responsible for ... Licensure as a Masters Social Worker in the State of Michigan (or actively working towards)

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Utilization Review Social Worker information

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$18

$36

$60

How much do utilization review social worker jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for utilization review social worker in Michigan is $36.85, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $42.31 per hour, depending on experience, location, and employer.

What is a utilization review social worker?

A Utilization Review Social Worker evaluates patient care to ensure it meets medical necessity and insurance guidelines. They review treatment plans, coordinate with healthcare providers, and communicate with insurance companies to secure appropriate coverage. Their goal is to optimize healthcare resources while ensuring patients receive necessary care. They also help prevent unnecessary hospitalizations and advocate for patient needs within healthcare systems.

What are the key skills and qualifications needed to thrive as a utilization review social worker?

To thrive as a Utilization Review Social Worker, you need a solid background in social work, case management, and healthcare regulations, typically supported by an MSW degree and licensure (LCSW or equivalent). Familiarity with utilization management software, EMR/EHR systems, and knowledge of insurance protocols are often required. Strong analytical thinking, attention to detail, effective communication, and empathy are key soft skills for success in this role. These abilities ensure informed decision-making, efficient patient care coordination, and effective advocacy during the review process.

What are some common challenges utilization review social workers face in their day-to-day work?

Utilization Review Social Workers often need to balance patient advocacy with healthcare cost containment, which can require navigating complex insurance guidelines and policies. They frequently review medical records to determine medical necessity and may have to communicate difficult decisions to patients, families, or care teams. Managing a high caseload while meeting documentation and regulatory requirements can also be demanding. However, this role offers opportunities for professional growth, multidisciplinary collaboration, and making a positive impact on patient care outcomes.

What are the most commonly searched types of Utilization Review Social Worker jobs in Michigan?

The most popular types of Utilization Review Social Worker jobs in Michigan are:

What are popular job titles related to Utilization Review Social Worker jobs in Michigan?

For Utilization Review Social Worker jobs in Michigan, the most frequently searched job titles are:

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The top searched job categories for Utilization Review Social Worker jobs in Michigan are:

Utilization Review Social Worker jobs near you
Infographic showing various Utilization Review Social Worker job openings in Michigan as of August 2026, with employment types broken down into 84% Full Time, 11% Part Time, and 5% Contract. Highlights an 100% In-person job distribution, with an average salary of $76,654 per year, or $36.9 per hour.

Utilization Review Analyst HYBRID (PCN 1542)

Oakland Community Health Network

Troy, MI • On-site

Full-time

Re-posted 9 days ago

Job description

Job Summary

Utilization Review Analyst conducts prospective, concurrent, and retrospective reviews of service authorizations, ensuring the appropriate, effective, and efficient use of acute psychiatric inpatient and state facility services. Reviews clinical documentation to determine medical necessity and authorize service in accordance with Michigan Medicaid Provider Manual requirements, organizational policies, and applicable regulatory standards. Collaborates with network providers, hospitals, and interdisciplinary teams to support timely authorization decisions, continuity of care, and appropriate transitions across the behavioral health continuum while maintaining accurate clinical documentation and regulatory compliance.

Essential Functions

  • Conduct concurrent utilization reviews of behavioral health services for acute psychiatric hospitals, state psychiatric facilities, and other levels of care to determine medical necessity, appropriateness of admission, continued stay, and discharge in accordance with Michigan Medicaid Provider Manual requirements and applicable regulatory requirements.
  • Review and analyze clinical documentation using established medical necessity criteria, clinical guidelines, contractual requirements, and reimbursement policies to make authorization determinations for inpatient behavioral health services.
  • Collaborate with network providers, acute care hospitals, state psychiatric facilities, and interdisciplinary treatment teams to facilitate utilization review activities, continuity of care, and effective discharge planning.
  • Apply evidence-based utilization management criteria and clinical protocols to establish continued stay review intervals and determine authorization status.
  • Document clinical reviews, authorization decisions, and supporting rationale accurately and within required timeframes in accordance with organizational, contractual, and accreditation standards.
  • Utilize clinical knowledge of behavioral health services, Michigan Medicaid Provider Manual requirements and organizational policies to ensure appropriate utilization of services and compliance with applicable regulations.
  • Participate in quality improvement initiatives, interdisciplinary workgroups, provider collaboration, audits, appeals, and other utilization management and review activities to support organizational performance and regulatory compliance
  • Perform additional duties and special projects assigned.

Job Requirements and Qualifications

Education: 

  • Master's degree in mental health field.

Training Requirements (licenses, programs, or certificates): 

  • Possession and maintenance of a current, unrestricted State of Michigan professional license in one of the following disciplines:
    • Licensed Psychologist (LLP or LP)
    • Licensed Master's Social Worker (LMSW)
    • Licensed Professional Counselor (LPC)
    • Licensed Marriage and Family Therapist (LMFT)
    • Registered Nurse (RN)
Must maintain Child Diagnostic and Treatment Professional (CDTP) eligibility, including 24 hours of annual child-specific training.

Experience Requirements:

  • Minimum of three (3) years of relevant post-graduate clinical experience providing services to adults with mental illness, intellectual or developmental disabilities, and/or substance use disorders, as well as children with serious emotional disturbance and/or intellectual or developmental disabilities.

Preferred Experience:

  • Experience within a Community Mental Health Services Program (CMHSP), Prepaid Inpatient Health Plan (PIHP), Managed Care Organization (MCO), hospital, or behavioral health setting.
  • Experience withutilizationof the MCG Parity Tool.
  • Experience within the Oakland Community Health Network (OCHN) provider network.

Knowledge Requirements: 

  • Knowledge of the Michigan Mental Health Code. 
  • Medicaid rules, regulations, and Michigan Medicaid Provider Manual. 
  • Managed Careandutilizationmanagementprinciples.
  • Preference for knowledge of thePIHP responsibilities forutilizationmanagement. 

Job Specific Competencies/Skills:

  • Demonstrated strong interpersonal skills with a proven ability to collaborate effectively in cross-functional and team-oriented environments.
  • Skilled in negotiation and stakeholder engagement, fostering productive relationships, and achieving mutually beneficial outcomes.
  • Excellent written and verbal communication skills, with the ability to convey complex information clearly and professionally.
  • Proficient in computer applications and project management practices, ensuring efficient coordination, execution, and successful delivery of initiatives.

Oakland Community Health Network’s Core Competencies:

  • Interacting with others in a way that gives them confidence in one’s intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
  • Making customers and their needs a primary focus of one’s actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
  • Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning) 
  • Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
  • Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Additional Information

(Travel required, physical requirements,  schedules, etc.):

  • Must have available means of transportation to and from OCHN and for required offsite meetings or site visits.
  • Must be available for meetings and events which may occur outside of standard office hours.
  • Hybrid (onsite/remote) work schedule available.
  • The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.

OCHN is committed to building a diverse team and fostering an inclusive and equitable culture. We are proud to be an equal opportunity employer that embraces and encourages our employees’ differences. This includes (but is not limited to) ability, age, color, family type, gender expression and identity, individual expression, medical conditions, national origin, pregnancy, race, religion, sexual orientation, veteran status, and all other diverse and wonderful characteristics.

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