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Utilization Review Jobs in Rochester Hills, MI (NOW HIRING)

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 ...

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 ...

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All JobsUtilization Review JobsUtilization Review Jobs in Rochester Hills, MI

Utilization Review information

See Rochester Hills, MI salary details

$19

$38

$63

How much do utilization review jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for utilization review in Rochester Hills, MI is $38.92, according to ZipRecruiter salary data. Most workers in this role earn between $30.77 and $44.71 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

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

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Rochester Hills, MI?

The most popular types of Utilization Review jobs in Rochester Hills, MI are:

What are popular job titles related to Utilization Review jobs in Rochester Hills, MI?

For Utilization Review jobs in Rochester Hills, MI, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Rochester Hills, MI look for?

The top searched job categories for Utilization Review jobs in Rochester Hills, MI are:

What cities near Rochester Hills, MI are hiring for Utilization Review jobs?

Cities near Rochester Hills, MI with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Rochester Hills, MI as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $80,950 per year, or $38.9 per hour.

RN Utilization Management Coordinator

Spectrum Health

Southfield, MI • Hybrid

Part-time

Medical, Retirement

Posted 5 days ago

Job description

Scope of work

This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.
  • Participates within the department to meet expected objectives and outcomes.
  • Meets or exceeds expectations related to behavior and performance. Meets individual and departmental objectives established for Quality, Satisfaction, Growth and Financial Success.
  • Conducts timely and accurate utilization reviews, as assigned, using organization-approved UR criteria.
  • Works closely with physician advisors and medical staff to ensure appropriate level of care, including obtaining physician orders for patient class changes when needed.
  • Refers cases, as defined, for 2nd level medical necessity review.
  • Maintains daily contact with payers to obtain authorization and reauthorization information and addresses concurrent denials and/or audit requests.
  • Provides UR and clinical documentation is adequate and complies with payer requirements.
  • Schedules next review/follow-up reviews as required in accordance with organizational policy and procedure and payer requests.
  • Routinely collaborates with the System Clinical Appeals and Revenue Cycle departments to expedite billing and appeals processes.
  • Maintains and monitors assigned work queues within the Electronic Medical Record.
Qualifications
  • Required Associate's Degree Associates or technical degree.
  • Preferred Bachelor's Degree in nursing or related field.
  • 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
  • Hospital utilization review/utilization management experience. Preferred
  • Clinical appeals experience. Preferred
  • Registered Nurse (RN) - State of Michigan Upon Hire required

    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 - 25800 Northwestern Highway - Southfield

    Department Name

    Utilization Management - Diversified East WB Mkt

    Employment Type

    Part time

    Shift

    Day (United States of America)

    Weekly Scheduled Hours

    0.04

    Hours of Work

    8

    Days Worked

    Monday - Friday

    Weekend Frequency

    N/A

    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.

    Apply