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

ICONMA

Registered Nurse-Review Analys

Detroit, MI · On-site

Review, research and authorize requests for authorization of elective, direct, ancillary, urgent ... One (1) year of utilization management preferred. * Certification in Case Management may be ...

OpTech LLC

RN Utilization Management

Detroit, MI · On-site

Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ... Utilization Management experience/role * Technical - MS Office, Type 35+ WPM, Dual monitors ...

Corewell Health

RN Care Coordinator

Royal Oak, MI · On-site

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 ...

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

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 ...

Spectrum Health

RN Care Coordinator

Royal Oak, MI · On-site

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 ...

Spectrum Health

RN Care Coordinator

Dearborn, MI · On-site

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 ...

Spectrum Health

RN Care Coordinator

Dearborn, MI · On-site

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 ...

Corewell Health

RN Care Coordinator

Dearborn, MI · On-site

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 ...

TEEMA

Case Manager

Detroit, MI · On-site

$55 - $60/hr

MANAGER IS VERY STRICT ON THE RECENT INPATIENT CASE MANAGEMENT EXPERIENCE - TELEPHONIC, UTILIZATION REVIEW, PSYCHOLOGICAL EXPERIENCE DOES NOT APPLY TO THIS REQUIREMENT.

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Utilization Review information

See Rochester Hills, MI salary details

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$38

$63

How much do utilization review jobs pay per hour?

As of Sep 4, 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:

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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.

Medical Review Specialist- REMOTE (EST zone)

MEDLOGIX, LLC

Southfield, MI • On-site

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

ReviewWorks, a Medlogix company founded in 1989 located in Northville, Michigan. Provides comprehensive Medical Review Services, Medical Case Management Services and Vocational Rehabilitation Services to customers that include self-insured entities, third party administrators and insurance carriers.


TITLE: 

Medical Review Specialist

TYPE:

Full time – (40 hours per week)

Non-Exempt

Remote- EST time zone


POSITION SUMMARY:

The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations for Michigan Workers' Compensation claims. The incumbent is also responsible for the quality timeliness and customer service for assigned accounts.


ESSENTIAL FUNCTIONS:

  • Reviews medical bills and documentation according to guidelines and RW policies and procedures.
  • Determines if treatment is related and necessary to the covered injury.
  • Advises reimbursement recommendations are appropriate.
  • Provides customer service to adjusters, providers, and claimants regarding bill review. 
  • Assesses appropriateness and duration of care provided, for possible utilization review.
  • Recommends independent medical evaluations (IME) to adjusters when necessary.
  • Act as a resource to other staff members to facilitate completion of a quality product. 
  • Use appropriate reference material as necessary to perform professional review.
  • Meets company productivity standards. 
  • Meets company quality standards.


Professional Background:


Certified Professional Coder – required

1+ years medical coding experience – CPT, ICD-10 - preferred

1+ years’ experience in Medical Bill Repricing – preferred

Michigan Workers' Compensation experience- preferred

 

SKILLS AND ABILITIES:


Ability to apply clinical knowledge and/or coding expertise in bill review

Ability to read, write, speak, and understand English well

Ability to understand and follow written and oral instructions

Possess strong verbal and interpersonal skills

Ability to multi-task 

Possess problems solving skills

Ability to sit for long periods at a computer terminal keyboarding

PC skills – required 

Knowledge of Microsoft Office Products – required 

Ability to operate standard office equipment including telephone

 

PERSONAL CHARACTERISTICS:

Initiative, drive, creativity and persistence

Good organizational skills

Highest professional ethics

Ability to work independently



EEOC STATEMENT:

Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.