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Chart Utilization Review Jobs in Appleton, WI (NOW HIRING)

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 ...

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Chart Utilization Review information

See Appleton, WI salary details

$20

$41

$67

How much do chart utilization review jobs pay per hour?

As of May 29, 2026, the average hourly pay for chart utilization review in Appleton, WI is $41.26, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.36 per hour, depending on experience, location, and employer.

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 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 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 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 Appleton, WI? For Chart Utilization Review jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Appleton, WI look for? The top searched job categories for Chart Utilization Review jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Chart Utilization Review jobs? Cities near Appleton, WI with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
MDS Coordinator

MDS Coordinator

Eden Senior Care

Oshkosh, WI • On-site

$80K - $90K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 22 days ago

Job description

Eden Senior Care, founded in 2016, is a growing Healthcare Management company focused on managing and operating Skilled Nursing, Rehabilitation, and Assisted Living communities in Minnesota, Wisconsin & Ohio. Our mission with each community is to support their success by providing strong leadership, corporate support, and the resources and tools to realize their goals. Edenbrook of Oshkosh promotes and encourages the success of each of its employees and values the individual experience of its guests and their families.

Edenbrook of Oshkosh is a skilled nursing facility located in Oshkosh, Wisconsin, as part of the Eden Senior Care network. We are looking for a dedicated MDS Coordinator to become a valued member of our compassionate and skilled team.


Position: MDS Coordinator ($7,500 Sign on bonus)

  • $7,500 Sign-on bonus paid in 4 quarters.
  • Monday–Friday schedule.
  • No on‑call requirements, no shift coverage, and no call rotation
  • AAPACN membership support

Salary is negotiable and based on experience and skill set. Looking for someone with MDS experience.

Candidates must be well-versed in MDS, RAI, and Clinical Reimbursement. Prior experience with Point Click Care (PCC) preferred.


Essential Duties and Responsibilities:

  • MDS scheduling, set up and completion
  • New admission authorizations, updates, communication with family/insurance providers, communication with case managers
  • ICD 10 coding for all new admissions and continual updating for LTC population
  • Participate in the implementation, updating and review of the resident care plan
  • Attend/communicate with family’s and residents on current plan of care, insurance needs, and discharge needs – attend care conferences
  • Educate IDT on needs of the MDS, Assessments and Skilled care service requirements
  • Run Utilization Review Meetings and ensure PDPM scores and rates are validated
  • Review and Educate IDT/Staff to ensure proper documentation is maintained
  • Maintain Insight/Participation to facility Quality Measures and QAPI process
  • Chart Reviews/Audits as needed
  • Assist IDT during Survey process

Qualifications:

  • Must hold an active LPN or RN license in the state of Wisconsin.
  • Strong knowledge of the MDS process- 3+ years’ experience preferred.
  • Strong knowledge of ICD 10 coding/coding guidelines, Medicare Chapter 8 Manual, RAI Manual
  • Possesses good organization skills-
  • Excel document, Teams, or Zoom platform experience a plus!
  • Excellent in written and oral communication skills.

Benefits:

  • Health, Dental, and Vision benefits
  • Vacation/Holiday/Sick time
  • 401k with company match
  • Tuition Reimbursement
  • Supportive working environment and culture

Keywords:

MDS, Reimbursement. RAI, Minimum Data Set, Medicare, Insurance, Medicaid, RNAC, AANAC, RAC-CT, RNAC-CE