Registered Nurse - Utilization Review

Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus.

General Summary

Part-Time Benefit Eligible

Schedule: 20 hours per week, day shift

About the Department

Join the Health Alliance Plan (HAP) team, a mission-driven health plan serving members across Michigan. HAP combines healthcare expertise with a commitment to improving outcomes through innovative coverage, care management, and wellness programs. As part of Henry Ford Health, HAP offers opportunities to shape the future of health and insurance services, ensuring members receive high-quality, cost-effective care in the most appropriate settings.

Role Overview

As a Utilization Review (UR) Nurse, you will ensure services meet members' health needs by identifying, assessing, planning, coordinating, monitoring, and evaluating healthcare services and outcomes. You will collaborate with the patient care team to promote high-quality care, reduce length of stay, and ensure efficient resource utilization. Your work will directly impact the delivery of care and the appropriate reimbursement of services, including discharge planning and aftercare support.

What We Offer

Join a team where you can grow your career through collaboration, mission-driven work, and continuous learning opportunities. Be part of an organization that values innovation, excellence, and making a meaningful impact on healthcare.

Join Our Team

Ready to make a difference? Apply now and be part of our mission to provide exceptional care and shape the future of health services.

Requirements

Nursing Diploma or equivalent, Bachelor of Science in Nursing degree preferred.; Four (4) years of hospital clinical experience in medical, surgical, orthopedic, neuro-surgery, or pediatric nursing.; Demonstrated knowledge of pathophysiology with application of critical thinking skills.; Current, valid Michigan license to practice as a Registered Nurse without conditions, limitations, or restrictions.; Knowledge of ICD-9/ICD-10 and CPT coding, medical necessity criteria, and medical terminology.; Excellent verbal and written communication skills, including telephone etiquette.; Proficiency in Microsoft Office Suite and typing skills.

Nice to have

Two (2) years of Utilization Management and/or Hospital discharge planning in the acute care setting within the past four (4) years.; Knowledge of Medicare, Medicaid, and NCQA guidelines and use of the CMS website for research.