ZipRecruiter

Log In

1

Case Manager Utilization Review Nurse Jobs in Racine, WI

Addus HomeCare

RN Case Manager

Waukegan, IL · On-site

$80K - $97K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Hospice Registered Nurse (RN) Case Manager - Full-Time JourneyCare Hospice is seeking a compassionate and experienced Hospice RN Case Manager to provide patient-centered, end-of-life care in the ...

New

Addus HomeCare

RN Case Manager

Zion, IL · On-site

$80K - $97K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Hospice Registered Nurse (RN) Case Manager - Full-Time JourneyCare Hospice is seeking a compassionate and experienced Hospice RN Case Manager to provide patient-centered, end-of-life care in the ...

New

Moments Hospice

RN Case Manager

Racine, WI · On-site

$75K - $90K/yr

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Moments Hospice

RN Case Manager

Milwaukee, WI

$75K - $90K/yr

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

ICONMA

RN Case Manager

Waterford, WI · On-site

  • Medical

RN Case Manager Our client, a Healthcare company, is looking for an RN Case Manager for their Waterford, WI location. Responsibilities: * Perform comprehensive assessment of high risk members.

Hire Talent

RN HH Case Manager

Burlington, WI · On-site

The RN Case Manager will coordinate and manage care for patients with end-stage illnesses, ensuring comfort-focused care in various home-based settings. This role requires strong clinical judgment ...

Luther Manor

Hospice-RN Case Manager

Wauwatosa, WI

$72K - $92K/yr

BE APART OF LUTHER MANOR'S HOSPICE TEAM FULL TIME RN CASE MANAGER POSITION AVAILABLE The Luther Manor Hospice RN Case Manager gives skilled nursing care to patients in their homes; administers ...

previous pagenext page

Showing results 21-40

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.

BH Case Manager: Weekend Program

Advocate Aurora Health

Wauwatosa, WI • On-site

$33.05 - $49.60/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Advocate Aurora Health rating

7.7

Company rating: 7.7 out of 10

Based on 779 frontline employees who took The Breakroom Quiz

157th of 887 rated healthcare providers

Job description

Department:
11200 Aurora Psychiatric Hospital - Case Management
Status:
Part time
Benefits Eligible:
No
Hours Per Week:
18
Schedule Details/Additional Information:
Position is every Friday, Saturday and Sunday from 0730 to 1600. Start time is flexible. Must be available to 1700 via Pager, if needed. Per weekend program policy one weekend off per quarter.
Pay Range
$33.05 - $49.60
Major Responsibilities:
  • Coordinates discharge planning, utilizing specialty services as needed. Monitors and ensures the discharge plans are completed in a timely manner. Facilitates calls to specialists as ordered (i.e. primary care physician, therapists). Works with families providing information and education services as needed.
  • Reviews clinical/insurance information and completes data gathering if necessary. Explains estimated benefit information to patient and assist the patient in exploring financial options as needed.
  • Obtains pre-authorization from managed care company. Performs ongoing concurrent reviews with payor source, maintaining written records of contacts. Investigates and negotiates different care options with the payor source/insurance company. Keeps the physician, treatment team, patient, family and financial counselor aware of review status.
  • Initiates the denial/appeal process for non-certified care, following through with all required paperwork and communications.
  • Assists with the development and maintenance of standards for case management across the Aurora Behavioral Health Services system.
  • Facilitates communications between and negotiates with the patient/family, physicians, nurses, dietary, rehab, homecare, social services, and other disciplines that need to collaborate to provide care for the patient.
  • Collaborates and coordinates efforts with treatment team members to complete the discharge plan in a timely manner. Attends and participates in treatment teams and unit meetings and may be assigned to lead and coordinate meetings as needed.
  • Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration, and/or Certification Required:
  • Registered Nurse license issued by the state in which the team member practices, or
  • Social Worker license issued by the state of Wisconsin, or
  • Professional Counselor license issued by the state of Wisconsin, and
  • Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association (AHA).

Education Required:
  • Bachelor's Degree in Nursing, or
  • Master's Degree in Social Work, or
  • Master's Degree in Psychology, Counseling.

Experience Required:
  • Typically requires 3 years of experience in behavioral health services that includes experiences in assessments, discharge planning and utilization review in a managed care environment.

Knowledge, Skills & Abilities Required:
  • Demonstrated leadership skills and ability to work independently.
  • Must have excellent oral, written communication and problem solving skills.
  • Demonstrated working knowledge of reimbursement methods and referral sources.
  • Demonstrated working knowledge of the State of Wisconsin Mental Health and Developmental Disabilities Code.
  • Knowledge of state and federal mental health and chemical dependency regulations.

Physical Requirements and Working Conditions:
  • Will frequently be required to lift 25 lbs. without assistance.
  • Will occasionally be required to lift over 25 lbs. with assistance.
  • May be exposed to the following hazards: mechanical, chemical, blood and body fluids.
  • Must be able to sit, stand, walk, squat, bend, and reach above shoulders and twist.
  • Ability to utilize proper de-escalation techniques when working with agitated patients.
  • Demonstrates flexibility in an environment that requires the ability to multitask.
  • Operates all equipment necessary to perform the job.
  • Any exception to the above requirements must be demonstrated through Employee Health.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:
Compensation
  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
  • Premium pay such as shift, on call, and more based on a teammate's job
  • Incentive pay for select positions
  • Opportunity for annual increases based on performance

Benefits and more
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

What Advocate Aurora Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Advocate Health logo

About Advocate Health

Sourced by ZipRecruiter

Advocate Healthcare, based in Oak Lawn, Illinois, United States, is a leading figure in the health care industry. Accessible via their official website, 'advocatehealth.com', this organization provides a wide variety of medical services and treatment options. Founded in 1995 through a merger of Evangelical Health Systems Corporation and Lutheran General HealthSystem, Advocate Healthcare has grown exponentially over the years. Now, it operates more than 400 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, five Level I trauma centers, and three Level II trauma centers. Upholding their values of equality, compassion, excellence, partnership and stewardship, Advocate Healthcare's mission is centered on building lifelong relationships with patients by delivering the best health outcomes and highest level of service through an integrated approach to care and wellness.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Charlotte, NC, US

View All Advocate Health Jobs

Apply