Healthcare Utilization Manager – Case Management Leader

Returning Applicant or New Applicant?; Detroit (MI); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

401(k) with employer match

Paid time off (PTO)

Career development

Job summary

Detroit Medical Center (DMC) seeks a seasoned Utilization Manager to lead the Utilization Review program within Case Management, ensuring medical necessity and timely transition planning for safe discharges and reduced readmissions.

The role requires an active RN license with hospital case management or utilization review experience; BSN preferred and ACM certification encouraged. Strong leadership and communication skills are essential to collaborate across departments.

Qualifications

• Active RN license required with hospital experience in case management, utilization review or leadership.
• Bachelor of Science in Nursing (BSN) preferred; ACM certification preferred.
• Accredited Case Manager (ACM) preferred; Magnet Hospital status consideration may influence requirements.

Responsibilities

• Facilitate and support an effective Utilization Review program within Case Management.
• Manage medical necessity process and negotiate with payers as needed.
• Provide education to physicians, staff, and leaders on utilization and denial data.

Skills

Organizational skills

Verbal and written communication

Leadership / team coordination

Critical thinking

Problem solving

Computer literacy

Education

RN license

BSN preferred

ACM certification preferred

Job description

Detroit Medical Center (DMC) seeks a seasoned Utilization Manager to lead the Utilization Review program within Case Management, ensuring medical necessity and timely transition planning for safe discharges and reduced readmissions.

The role requires an active RN license with hospital case management or utilization review experience; BSN preferred and ACM certification encouraged. Strong leadership and communication skills are essential to collaborate across departments.