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Chart Utilization Review Jobs in Wisconsin (NOW HIRING)

WESTERN WISCONSIN HEALTH

Social Worker

Baldwin, WI · On-site

Participates in and has a strong understanding of Utilization Review principles and practice ... Collaborates with Providers to ensure chart documentation is supportive for hospital stay;

Western Wisconsin Health

Social Worker

Baldwin, WI · On-site

Participates in and has a strong understanding of Utilization Review principles and practice ... Collaborates with Providers to ensure chart documentation is supportive for hospital stay;

Western Wisconsin Health

Social Worker

Baldwin, WI · On-site

Participates in and has a strong understanding of Utilization Review principles and practice ... Collaborates with Providers to ensure chart documentation is supportive for hospital stay;

Eden Senior Care

MDS Coordinator

Oshkosh, WI · On-site

$80K - $90K/yr

Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ... Chart Reviews/Audits as needed * Assist IDT during Survey process Qualifications: * Must hold an ...

VITAS Healthcare

Team Manager Home Care

Milwaukee, WI · On-site

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

New

VITAS Healthcare

Team Manager Home Care

Milwaukee, WI · On-site

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

New

AdvisaCare

Home Health Intake Coordinator

Portage, WI · On-site

$19 - $26/hr

Utilization of Wellsky/Kinnser Agency Manager as EMR platform. ESSENTIAL DUTIES AND ... chart. * Obtain start of care authorization for managed care cases not requiring clinical ...

Kiongroup

Project Manager

Wauwatosa, WI · On-site

$88K - $125K/yr

Logistics and Supply Chain Careers at Dematic Chart your path! Whether you are an engineer ... Review and implement contract management plans, ensuring compliance with legal and regulatory ...

Southwest Health Center

HIM Specialist

Platteville, WI · On-site

$97K - $97K/yr

Performs chart preparation for scanning, removing difficult items to scan, removing staples and ... Performs quality review of scanned images to assure proper alignment, readability, and that all ...

Southwest Health

HIM Specialist

Platteville, WI · On-site

$97K - $97K/yr

Performs chart preparation for scanning, removing difficult items to scan, removing staples and ... Performs quality review of scanned images to assure proper alignment, readability, and that all ...

Prncares

Finance Director

Appleton, WI · On-site

$85 - $120/hr

Review of financial statements prepared by outside 3rd party includes doing an analysis of ... Prepares and reports key statistics through the effective utilization of information systems.

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Chart Utilization Review information

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Wisconsin? For Chart Utilization Review jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Wisconsin look for? The top searched job categories for Chart Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Chart Utilization Review jobs? Cities in Wisconsin with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Social Worker

WESTERN WISCONSIN HEALTH

Baldwin, WI • On-site

Other

Re-posted 12 days ago

Western Wisconsin Health rating

8.4

Company rating: 8.4 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

68th of 1,055 rated hospitals

Job description

Description
Western Wisconsin Health is seeking a full-time Social Worker (1.0 FTE). Social Services provides social work case management that optimizes patient functioning by linking patient with resources that provide services and opportunities to enhance successful quality outcomes. Social Services works collaboratively with providers, staff, and other service providers inside the organization and the community to ensure WWH delivers high quality health and wellness services for everyone we serve. All of this is done to support the organization's mission while living our values.
$6000 Signing Bonus:
  • $3000 paid on your first paycheck
  • $3000 paid after 6 months of employment

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Provides a wide range of social work modalities with individuals, families and groups based upon a social work assessment
  • Conducts on-going assessments, including gathering comprehensive information, to use in developing psychosocial assessments, interventions, and treatment strategies
  • Implements interventions that promote patient well-being and ensures a continuum of care
  • Advocates for the needs and interests of the patient to improve delivery of services
  • Demonstrates sensitivity to and awareness of cross-cultural issues and integrates this knowledge into practice
  • Maintains documentation of social work services that reflect the patient's pertinent information for assessment and treatment, social work involvement and outcomes, and in accordance of treatment plan
  • Provides resources and guidance to other health care providers in the psycho-social aspects of patient-care and to perform related duties
  • Collaborates with health care workers in treatment planning, care conferences and recommendations
  • Participates in and has a strong understanding of Utilization Review principles and practice
  • Responsibility for facility discharge planning and discharges including those with complicated psycho-social elements and provide follow up care where needed
  • Works with law enforcement, corporation counsel, and county departments to assist with legal aspects of patient care
  • Collaborates with Providers to ensure chart documentation is supportive for hospital stay;
  • Communicates with third party payers as required and provides information needed;
  • Coordinates care through the hospital stay and post discharge;
  • Coordinates Transitional Care Program and completes Transitional Care referrals;
  • Demonstrates awareness, understanding and respect of cultural diversity and patients of all ages and socioeconomic groups
  • Other duties as assigned.

Requirements
QUALIFICATIONS
Western Wisconsin Health expects employees to understand and to incorporate the values of our organization in their day-to-day practice. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Qualifications
  • Bachelor's degree in Social Work or related field with CSW

Preferred Qualifications
  • CSW
  • 2+ years related experience with utilization review and discharge planning
  • Experience with Transitional Care (Swing Bed) Program

Knowledge, Skills and Abilities
  • Maintain computer skills to effectively navigate the electronic health record, as well as seeking the web for purposes of education networking, and resources for efficient and productive practice
  • Knowledge of advanced care planning and Honoring Choices
  • Knowledge of available community resources and services
  • Maintain the integrity of highly confidential business and patient information
  • Display and promote high standards of ethical conduct and behaviors consistent with organizational standards
  • Exhibit excellent communication and organizational skills
  • Clearly and effectively convey information to patients
  • Ability to manage conflicting priorities and handle multiple tasks/projects concurrently
  • Ability to consistently carry out job responsibilities, able to acknowledge when commitments are not met, and take appropriate steps to fulfill responsibility

Work Schedule:
  • 1.0 FTE - Monday through Friday
  • Position shared with Adoray Home Health and Hospice (.2 of FTE dedicated here)

ABOUT WESTERN WISCONSIN HEALTH
Western Wisconsin Health is an integrated hospital and family practice clinic located in Western Wisconsin, just 30 minutes from downtown St. Paul on I-94. Join an exciting and growing team with a focus on the future of health care delivery!

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