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Case Manager Utilization Review Nurse Jobs in Racine, WI

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

  • Medical

Perform utilization review to assess medical necessity, care appropriateness, and compliance with ... Graduate of an accredited school of nursing (BSN preferred). * Two years of recent nursing ...

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

  • Medical

Vista Medical Center is seeking a dedicated and detail-oriented Case Manager - Registered Nurse (RN ... nurses, and other healthcare professionals to ensure smooth transitions.Perform utilization review ...

Froedtert

RN, Denials Management

Menomonee Falls, WI · On-site

$36.38 - $56.39/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assists the case managers with utilization review issues, and provides recommendations for process ... A minimum of 5 years of acute care nursing experience or 5 years nursing with relevant denials ...

FROEDTERT HEALTH

RN CASE MANAGER

Menomonee Falls, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Froedtert

RN CASE MANAGER

Milwaukee, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

FROEDTERT HEALTH

RN CASE MANAGER

Milwaukee, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Froedtert

RN CASE MANAGER

Menomonee Falls, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

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Showing results 1-20

All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Racine, WI

Case Manager Utilization Review Nurse information

See Racine, WI salary details

$18

$44

$75

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for case manager utilization review nurse in Racine, WI is $44.57, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $53.89 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.

What are popular job titles related to Case Manager Utilization Review Nurse jobs in Racine, WI?

For Case Manager Utilization Review Nurse jobs in Racine, WI, the most frequently searched job titles are:

What job categories do people searching Case Manager Utilization Review Nurse jobs in Racine, WI look for?

The top searched job categories for Case Manager Utilization Review Nurse jobs in Racine, WI are:

What cities near Racine, WI are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Racine, WI with the most Case Manager Utilization Review Nurse job openings:

Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Racine, WI as of August 2026, with employment types broken down into 74% Full Time, 14% Part Time, and 12% Contract. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $92,707 per year, or $44.6 per hour.

Case Manager Full Time and PRN

AHS Vista LLC

Waukegan, IL • On-site

$36 - $55/hr

Other

Medical

Re-posted 5 days ago

Job description

Vista Medical Center is seeking a dedicated and detail-oriented Case Manager - Registered Nurse (RN) to join our healthcare team. This role plays a crucial part in ensuring patients receive the best possible care by coordinating services, facilitating discharge planning, and optimizing the care continuum.
Responsibilities:
  • Collaborate with the healthcare team to assess, plan, implement, monitor, and evaluate patient care options and services.
  • Coordinate the case management process, ensuring patients receive appropriate care and resources.
  • Oversee the discharge planning process, working closely with physicians, nurses, and other healthcare professionals to ensure smooth transitions.
  • Perform utilization review to assess medical necessity, care appropriateness, and compliance with healthcare policies.
  • Support PHIP (Patient Health Improvement Programs) to enhance patient outcomes and overall care quality.
  • Maintain accurate and timely documentation of patient progress, care plans, and case management activities.
  • Provide education to patients, families, physicians, and the multidisciplinary team on case management processes, insurance approvals/denials, and available healthcare resources.
Requirements:
  • Graduate of an accredited school of nursing (BSN preferred).
  • Two years of recent nursing experience in an acute care setting.
  • Active RN License in the state of Illinois.
  • AHA CPR certification (must be current).
Why Join Vista Medical Center?
  • Opportunity to work in a dynamic and supportive healthcare environment.
  • Competitive salary and comprehensive benefits package.
  • Professional growth and development opportunities.

If you are a passionate Registered Nurse with a strong background in case management and patient advocacy, we encourage you to apply!

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