Medical Office Utilization Specialist

2 days ago


Detroit, Michigan, United States Detroit Medical Center Full time

The Detroit Medical Center (DMC) is seeking a highly skilled Registered Nurse to fill the role of RN Utilization Review in its esteemed medical office. As a key member of our team, you will play a crucial part in ensuring that patients receive optimal health care and access to necessary resources.

With a strong focus on patient-centered care, you will be responsible for coordinating effective resource utilization to help patients achieve their optimal health outcomes. This involves working closely with payors, physicians, and other healthcare professionals to ensure that care is provided at the appropriate level of complexity and intensity based on medical necessity.

Key responsibilities of this role include:

  • Collaborating with payors to authorize appropriate levels of care and length of stay for medically necessary services
  • Working with Care Coordination to ensure efficient throughput while maintaining high-quality care
  • Securing and documenting authorization for services from payors
  • Performing accurate medical necessity screening and timely submission for Physician Advisor reviews

In addition to these critical responsibilities, you will also be accountable for promoting prudent utilization of all resources by evaluating available resources and balancing cost and quality to ensure optimal clinical and financial outcomes.

The DMC offers a comprehensive compensation package, including an estimated annual salary of $ $105,000 - $140,000 based on experience, education, and certifications. We are committed to providing a work environment that fosters collaboration, innovation, and continuous learning.

About the Detroit Medical Center:

The DMC is a nationally recognized academic medical center with a long history of excellence in patient care, education, and research. Our state-of-the-art facilities and cutting-edge technology enable us to provide world-class care to patients from across the country.

We are proud to offer a wide range of benefits, including medical, dental, and vision insurance, as well as 401(k) savings plan, employee assistance program, and more. If you are passionate about delivering exceptional patient care and want to join a team of dedicated professionals who share your values, apply now to become a part of the DMC family.



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