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Utilization Reviewer Jobs in Howell, MI (NOW HIRING)

Corewell Health

RN Care Coordinator

Northville, MI · On-site

Part Time- 20 Hours A Week Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates ...

New

Corewell Health

RN Care Coordinator

Farmington, 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 ...

Memorial Healthcare

RN Case Manager

Owosso, MI · On-site

Prior Case Management or utilization review experience preferred. Case Management certification preferred. Essential Physical Requirements Must be able to sit or stand for long periods of time; be ...

Memorial Healthcare

RN Case Manager

Owosso, MI · On-site

Prior Case Management or utilization review experience preferred. Case Management certification preferred. ESSENTIAL PHYSICAL REQUIREMENTS: Must be able to sit or stand for long periods of time; be ...

Acadia Healthcare

RN - Admissions

West Bloomfield, MI · On-site

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for ...

New

Acadia Healthcare

RN - Admissions

West Bloomfield, MI · On-site

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for ...

Rushton Recovery

Licensed Social Worker

South Lyon, MI · On-site

Proficiency in intake assessments, treatment planning, discharge planning, utilization review, and case management. Join our team and make a meaningful impact on the lives of those we serve through ...

Singh

Registered Nurse

West Bloomfield, MI

Participates in utilization review of medical records as assigned. 19. Gives total patient care as needed. 20. Takes on-call duty nights, weekends and holidays, as assigned. 21. Completes and submits ...

Singh

Registered Nurse

West Bloomfield, MI · On-site

Participates in utilization review of medical records as assigned. 19. Gives total patient care as needed. 20. Takes on-call duty nights, weekends and holidays, as assigned. 21. Completes and submits ...

Trinity Health

Flex Clinical Pharmacist

Brighton, MI · On-site

$113K - $135K/yr

Documents clinical interventions, participates in quality assurance monitors, drug utilization reviews, pharmacoeconomic analysis, and monitors medication therapy outcomes as assigned. Consults with ...

Trinityhealth

Flex Clinical Pharmacist

Brighton, MI · On-site

$113K - $135K/yr

Documents clinical interventions, participates in quality assurance monitors, drug utilization reviews, pharmacoeconomic analysis, and monitors medication therapy outcomes as assigned. Consults with ...

Trinity Health

Flex Clinical Pharmacist

Brighton, MI · On-site

$113K - $135K/yr

Documents clinical interventions, participates in quality assurance monitors, drug utilization reviews, pharmacoeconomic analysis, and monitors medication therapy outcomes as assigned. Consults with ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Howell, MI

Utilization Reviewer information

See Howell, MI salary details

$29K

$35.6K

$41.2K

How much do utilization reviewer jobs pay per year?

As of Aug 11, 2026, the average yearly pay for utilization reviewer in Howell, MI is $35,552.00, according to ZipRecruiter salary data. Most workers in this role earn between $31,800.00 and $39,300.00 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
What cities near Howell, MI are hiring for Utilization Reviewer jobs? Cities near Howell, MI with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Howell, MI as of August 2026, with employment types broken down into 2% As Needed, 74% Full Time, 22% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $35,552 per year, or $17.1 per hour.

RN Care Coordinator

Corewell Health

Northville, MI • On-site

Other

Posted 3 days ago

New

Corewell Health rating

7.0

Company rating: 7.0 out of 10

Based on 775 frontline employees who took The Breakroom Quiz

416th of 887 rated healthcare providers

Job description

Part Time- 20 Hours A Week

Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.

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 includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs. Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.

Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations. Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately. Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.

Qualifications

Required Bachelor's Degree Graduate of an accredited school of nursing. Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire. 2 years of relevant experience Minimum two years' experience in the acute care setting. Required 3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State of Michigan Upon Hire required CRT-at least one Certification from preferred list - Unknown Unknown Upon Hire required Or Basic Life Support (BLS) - AHA American Heart Association preferred Or Basic Life Support (BLS) - ARC American Red Cross preferred Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

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