Top 24 Utilization management Jobs in Hubbell, Mi

RN Care Management Program Specialist
OpTech LLC —Michigan
- $37 - $39 an hour
- Full-time
- Remote
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
2d
Registered Nurse
Optum —Houghton, MI
- $48.97 an hour
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Registered Nurse (RN) Manager Wound Care
UP Health System - Portage —Hancock, MI
- 8 hour shift
- Acute care
- Nursing
- RN License
- Disability insurance
- Health insurance
Quick Apply
Physician ED Claims Reviewer
Vytwo —United States
- Full-time
- Remote
- Mid-level
- 2 years
Quick Apply
Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract
Walker Healthforce, LLC —United States
- Contract
- Remote
- Nursing
- RN License
- 3 years
- Health insurance
- Dental insurance
Quick Apply
2d

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UR Coordinator, Full Time
RiverVista Behavioral Hospital —Columbus, OH
High school diploma required; associate or bachelor’s degree in nursing, healthcare administration, or related field preferred. Must be 21 or older.
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…

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utilization management jobs near hubbell, mi

RN Care Management Program Specialist

OpTech LLC -
Michigan

Quick Apply

Job Details

Full-time
$37 - $39 an hour
2 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Case assessment
RN License
CMS
CMS regulatory compliance
Utilization management
Clinical training
Quality improvement
Bachelor of Science in Nursing
Associate Degree in Nursing

Full Job Description

We are seeking an experienced Registered Nurse (RN) with strong Care Management and/or Utilization Management experience to support clinical training, quality reviews, audits, accreditation, and staff development.

Key Responsibilities

Provide clinical training and education to Care Management/Utilization Management staff.
Conduct clinical and quality reviews of cases.
Educate staff and providers on InterQual/MCG criteria, clinical policies, and procedures.
Develop and update training materials, manuals, and educational resources.
Mentor and support new employees during training and onboarding.
Assist with internal/external audits and accreditation activities.
Support implementation of new programs, systems, processes, and clinical criteria updates.
Analyze performance information and identify training or quality improvement opportunities.
Partner with leadership and subject matter experts on training and process improvements.

Required Qualifications

Current, unrestricted Michigan RN license.
Nursing Diploma or ADN required; BSN preferred.
5+ years healthcare experience.
3+ years Care Management and/or Utilization Management experience.
Experience with InterQual or MCG.
Knowledge of CMS, NCQA, HIPAA, and healthcare regulatory requirements.
Strong clinical assessment, analytical, communication, and training skills.

Preferred

CCM or other Case Management certification.
Health plan/managed care experience.
Clinical training, quality, audit, or accreditation experience.

Technology

Experience with CareAdvance, SharePoint, Excel, Word, Teams, Member Records portals, Virtual Desktop, and working across multiple systems/applications.

Ideal Candidate: An experienced RN who combines Care Management/UM expertise with clinical training, quality review, and staff mentoring experience.

Pay: $37.00 - $39.00 per hour

Benefits:

Dental insurance
Health insurance
Paid time off
Vision insurance

Experience:

Nursing : 5 years (Preferred)
Care Management: 1 year (Required)
Utilization Management: 1 year (Required)
InterQual or MCG: 1 year (Required)

License/Certification:

MI RN License (Required)

Work Location: Remote

Quick Apply

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utilization management jobs in hubbell, mi

RN Care Management Program Specialist

Registered Nurse

Registered Nurse (RN) Manager Wound Care

Physician ED Claims Reviewer

Remote Orthopedic Physician (MD/DO) Outpatient Prior Authorizations (IC to FTE)

Registered Nurse | Review Analyst I | Remote | Detroit, MI | Contract

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