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Chart Utilization Review Jobs in Wisconsin (NOW HIRING)

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 ...

Southeast Addiction Facilities Master

WI · On-site

$60 - $85/hr

Conduct chart reviews and documentation audits to ensure quality and regulatory compliance ... Monitor productivity and service utilization metrics. * Collaborate with leadership regarding ...

New

Nrg-Mgmt-LLC

Program Supervisor

Germantown, WI · On-site

$50 - $80/hr

Conduct chart reviews and documentation audits to ensure quality and regulatory compliance.Assist ... Monitor productivity and service utilization metrics.Collaborate with leadership regarding ...

New

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 information systems.

NRG MGMT LLC

Program Supervisor

Germantown, WI · On-site

$50K - $80K/yr

Conduct chart reviews and documentation audits to ensure quality and regulatory compliance ... Monitor productivity and service utilization metrics. * Collaborate with leadership regarding ...

Texas Health Action

WI · On-site

$210.60 - $257.40/hr

... utilization management. * Oversee clinical emergencies in clinic: syncope, anaphylaxis, drug ... Conduct a minimum 3% monthly chart review for each supervised APP. * Conduct scheduled 1:1 meetings ...

Impact Life

WI · On-site

$85 - $120/hr

Monitor program quality, engagement, utilization, outcomes, and continuity of care. * Partner with ... Participate in chart reviews, quality assurance, program evaluation, and corrective action planning ...

New

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 ... Develop and implement resource management plans, ensuring optimal allocation and utilization of ...

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 ... Develop and implement resource management plans, ensuring optimal allocation and utilization of ...

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Chart Utilization Review information

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 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 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, 12% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Registered Nurse Care Manager- Luxemburg, Kewaunee, Manitowoc

Prevea Health

Luxemburg, WI • On-site

Full-time

Re-posted 26 days ago

Key responsibilities

  • Coordinates comprehensive care management activities across the continuum, including pre-visit planning, care transitions, and follow-up after hospital or emergency department encounters.

  • Educates patients and families on disease management, treatment plans, preventive care, and clinical measurements.

  • Develops, implements, and evaluates individualized care plans in partnership with patients, families, and providers, establishing treatment goals and addressing barriers to successful outcomes.

Prevea Health rating

7.6

Company rating: 7.6 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

191st of 898 rated healthcare providers

Job description

This position will work 32 hours per week
RN (Care Manager)
Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.
Job Summary
The Registered Nurse (RN) Care Manager coordinates and manages the continuum of care for an assigned patient population to promote optimal health outcomes, effective resource utilization, and high-quality, patient-centered care. This role implements evidence-based clinical guidelines, supports care transitions, and collaborates with providers, patients, and families to reduce avoidable utilization and improve clinical, financial, and quality outcomes.
What you will do
  • Coordinates comprehensive care management activities across the continuum, including pre-visit planning, care transitions, follow-up after hospital or emergency department encounters, and collaboration with internal and external care teams.
  • Educates patients and families on disease management, treatment plans, preventive care, and clinical measurements, reinforcing self-management skills and informed decision-making.
  • Facilitates efficient care delivery by coordinating multiple clinician visits, diagnostic testing, and services, when possible, while identifying and connecting patients to appropriate insurance, financial, and community resources.
  • Develops, implements, and evaluates individualized care plans in partnership with patients, families, and providers, establishing treatment goals and addressing barriers to successful outcomes related to medications, appointments, social determinants, and adherence.
  • Implements standing orders and evidence-based protocols for medication refills, diagnostic testing, preventive services, and disease-specific management, ensuring timely and appropriate care delivery.
  • Manages transitions of care by reviewing external clinical information, contacting patients post-discharge, coordinating follow-up services, and developing written transition plans when patients move between care settings or providers.
  • On an as needed basis, prepares and reviews patient charts prior to appointments, conducts clinical triage to determine urgency of care needs, and provides telephonic nursing guidance within established protocols and scope of practice.

Education Qualifications
  • Graduation from an accredited and approved Nursing program Required
  • Bachelor's Degree in Nursing Preferred

Experience Qualifications
  • 3-5 years in a healthcare clinic setting Preferred

Skills and Abilities
  • Skilled in establishing and maintaining effective working relationships with patients, medical staff, and the public
  • Excellent interpersonal skills and behaviors
  • Knowledge of common safety hazards and precautions to establish a safe work environment
  • Competent in patient education/teaching
  • Ability to assist providers with exams, tests & treatments
  • Strong patient assessment skills in person and on the phone in a high-volume, fast-paced environment
  • Ability to administer immunizations and medications
  • Specialty skills as needed per department. Examples include IV starts, care/case management and pacemaker management.

Licenses and Certifications
  • Current Wisconsin RN license or compact equivalent (nurses must maintain or update their primary state of residence to Wisconsin to ensure continued eligibility under the compact) Upon Hire Required
  • CPR certification- Basic Life Support for Healthcare Providers certification from an approved program. Upon Hire Required

Physical Demands
  • Sit - Constantly
  • Stand - Rarely
  • Walk - Rarely
  • Drive - Rarely
  • Climb (Stairs/Ladders) - Rarely
  • Bend (Neck) - Occasionally
  • Bend (Waist) - Rarely
  • Squat - Rarely
  • Twist/Turn (Neck) - Frequently
  • Twist/Turn(Waist) - Occasionally
  • Lift/Carry 0-10 lbs. - Rarely
  • Lift/Carry 11-25 lbs. - Rarely
  • Lift/Carry 26-35 lbs. - Rarely
  • Lift/Carry 36-50 lbs. - Rarely
  • Push/Pull up to 10 lbs. - Occasionally
  • Push/Pull 11-25 lbs. - Occasionally
  • Push/Pull 26-35 lbs. - Occasionally
  • Push/Pull 36-50 lbs. - Occasionally
  • Push/Pull 51-75 lbs. - Occasionally
  • Push/Pull 76-100 lbs. - Rarely
  • Reach (Above shoulder level) - Occasionally
  • Reach (Below shoulder level) - Occasionally
  • Simple Grasping (Hands/Arms) - Constantly
  • Fine Manipulation (Hands/Arms) - Constantly
  • Gross Manipulation (Hands/Arms) - Frequently

Working Conditions
  • Noise - Occasionally

Travel Requirements
  • 5%

Hearing Requirements
  • Hears Whispers < 3 feet - Constantly
  • Hears Whispers 3-8 feet - Constantly

Vision Requirements
  • Color Discrimination - Constantly
  • Near Vision (Correctable to Jaeger 2 or 20/40 binocular) - Constantly
  • Distance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly

Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify

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