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Utilization Jobs in Michigan (NOW HIRING)

Bestica Healthcare

RN - Utilization Review

Lansing, MI · On-site

Utilization Review Rn Travel Position We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative.

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All JobsUtilization JobsUtilization Jobs in Michigan

Utilization information

See Michigan salary details

$18

$36

$60

How much do utilization jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for utilization 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 the difference between Utilization vs Resource Coordinator?

AspectUtilizationResource Coordinator
Primary FocusMeasuring and optimizing how staff time is usedManaging and assigning resources for projects
Required CredentialsOften no specific credentials, but industry experience helpsTypically requires organizational or project management skills
Work EnvironmentCorporate, healthcare, or consulting firmsProject teams, staffing agencies, or departments
Common UsageTracking staff utilization ratesAllocating resources to projects or tasks

Utilization focuses on measuring how effectively staff time is used, often to improve productivity. Resource Coordinator involves actively managing and assigning resources to ensure project needs are met. While related, utilization is more about analysis, and resource coordination is about execution and management.

What are utilization specialists?

Utilization specialists are professionals who review and evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. They work closely with healthcare providers, insurance companies, and patients to ensure that care is delivered according to established guidelines and that resources are used effectively. Their goal is to help manage costs while ensuring patients receive the appropriate level of care.

What are some of the common challenges faced by Utilization Review Specialists when assessing medical necessity of services?

Utilization Review Specialists often encounter the challenge of balancing patient advocacy with cost-effective care. They must stay updated on evolving insurance policies and clinical guidelines, which can be complex and change frequently. Additionally, coordinating with physicians and healthcare staff to obtain necessary documentation and clarifying treatment plans can be time-consuming. Strong communication skills and attention to detail are essential to ensure timely and accurate reviews, while also maintaining positive working relationships with clinical teams.

What are the key skills and qualifications needed to thrive as a Utilization Review Specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN/LVN), strong analytical skills, and knowledge of insurance and medical necessity criteria. Familiarity with utilization management software, ICD-10/CPT coding, and regulatory guidelines like Medicare and Medicaid is typically required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These abilities are crucial to accurately evaluating patient care needs, ensuring regulatory compliance, and optimizing resource use within healthcare organizations.
What are the most commonly searched types of Utilization jobs in Michigan? The most popular types of Utilization jobs in Michigan are:
What cities in Michigan are hiring for Utilization jobs? Cities in Michigan with the most Utilization job openings:
Utilization jobs near you
Infographic showing various Utilization job openings in Michigan as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $76,654 per year, or $36.9 per hour.
Utilization Review Nurse Case Manager

Utilization Review Nurse Case Manager

Emergent Holdings

Lansing, MI • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description


The Utilization Review Nurse is responsible for applying medical knowledge, judgment, jurisdictional rules, and medical treatment guidelines to review workers' compensation medical necessity reviews. The Utilization Review (UR) Nurse engages with physicians, peer reviewers and collaborates with claim handlers to determine appropriate treatment decisions. The UR Nurse must be able to demonstrate and be accountable for the standards of practice, policies and procedures, quality assurance, and the goals of the organization. Also, review treatment of claimants through the workers' compensation system based on the individual's diagnosis, and jurisdictional regulations.
  • Review medical records and treatment plans to determine medical necessity and appropriateness of medical treatment based upon established guidelines, and jurisdictional rules.
  • Conduct prospective, concurrent, and retrospective medical necessity reviews.
  • Apply standardized and appropriate clinical guidelines and document claim file to justify treatment approvals.
  • Issue pre authorizations for procedures, diagnostic tests, therapies, and equipment.
  • Collaborate with physicians and healthcare providers to clarify treatment requests.
  • Communicate with claims handlers regarding treatment decisions, utilization trends, and determinations.
  • Ensure UR processes comply with state workers' compensation guidelines and regulatory bodies.
  • Maintain timely and accurate documentation that complies with regulatory and URAC requirements.
  • Stay updated on changes in healthcare policies and workers' compensation rules.
  • Prepare and submit clinical appeals when treatment requests are denied, supporting medical necessity with proper documentation.
EDUCATION
  • Registered nurse license active and unrestricted required.
  • Bachelor's degree in nursing (BSN) preferred. Compact and or multiple state RN licenses, or the ability to obtain additional licenses.
EXPERIENCE
  • Five (5) years of active patient or clinical care experience as a Registered Nurse is required.
  • Three (3) years workers compensation case management/utilization review, occupational health, rehabilitation or insurance experience preferred.
QUALIFICATIONS
  • Excellent oral and written communication skills.
  • Demonstrated leadership and project management abilities.
  • Ability and proficiency in the use of computers and Company standard software specific to position, including Microsoft Office products.
  • Strong clinical assessment, critical thinking, and communication skills.
  • Expertise in evidenced based guidelines.
  • Ability to analyze utilization data and identify trends.
  • Knowledge of clinical care and jurisdictional requirements.
  • Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
  • Demonstrates use of critical thinking, attention to detail, sound clinical judgement and assessment for decision making.
  • Demonstrates courteous, professional demeanor, ability to work collaboratively within a team and independently.
  • Strong working knowledge of workers' compensation laws.
  • Must possess strong negotiation skills and decision-making ability.
  • Attention to detail and analytical skills required.
  • Ability to exercise good judgement in evaluating and determining appropriateness of various actions within the process of workers compensation claims.
  • Ability to make competent, independent decisions and maintain confidentially where appropriate.
    PAY RANGE:
    Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not the standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $73,600 and $123,200.
    We are an Equal Opportunity Employer. We will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
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