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Utilization Reviewer Jobs in Michigan (NOW HIRING)

Integra Partners

Director of Utilization Management

Troy, MI · On-site +1

$160K - $160K/yr

Prepare and maintain Utilization Review Plan policies and procedures * Obtain or maintain certification or license in states when performing Utilization Review * Work with Chief Medical Director to ...

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 Reviewer JobsUtilization Reviewer Jobs in Michigan

Utilization Reviewer information

See Michigan salary details

$27K

$33.1K

$38.4K

How much do utilization reviewer jobs pay per year?

As of Aug 7, 2026, the average yearly pay for utilization reviewer in Michigan is $33,114.00, according to ZipRecruiter salary data. Most workers in this role earn between $29,600.00 and $36,600.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
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What are popular job titles related to Utilization Reviewer jobs in MI? For Utilization Reviewer jobs in MI, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Michigan as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $33,114 per year, or $15.9 per hour.

Access-Utilization Manager

Region 10 PIHP

Port Huron, MI

Full-time

Posted 14 days ago

Job description

Essential Functions

The Access-UM Manager position is a program and administrative management position providing operational oversight and direction for behavioral health services utilization across the region respective to the Region 10 PIHP Access Unit and Utilization Management Unit. An employee at this level is required to perform, among others, the following essential duties:

Provide oversight of Access-UM clinical operations, including backup to the Lead Clinician and clinical staff

Provide direction and supervision of all Access-UM clinical staff and program support staff

Monitor and ensure daily staff coverage, including on-call after-hours coverage

Ensure completion of Access Management System reports

Provide oversight of regional Utilization Management (UM) and Utilization Review (UR) activities across the CMH and SUD provider networks, including case finding and case record review, protocol updates, and quarterly and end of year activity reports

Assist in the development and periodic evaluation of regional clinical practice guidelines

Facilitate and support provider network implementation and sustainment activities pertaining to MDHHS evidence-based practices and UM/UR guidance documents

Complete staff performance reviews and staff development plans

Develop Access-UM Staff Meeting Agenda and conduct staff meetings

Assist with developing and implementing regional Utilization Management Program Plan

Provide lead clinical support and participation on Region 10 committees (UMC, IPLT, SERC), including backup to the UMC Chair

Participate on other committees and work groups as assigned

Provide SME input and representation on HSAG audit Standards and contract monitoring

Serve as backup to the CCO on the state-wide UM Directors Group

Provide technical guidance on clinical issues related to regional Credentialing and Privileging policy standards and Grievance and Appeal reviews and policy standards

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