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Contract Utilization Review Jobs in Appleton, WI

Network Health

Associate Medical Director

Menasha, WI · On-site +1

... of utilization review and quality assessment processes * Provide medical consultation as requested ... Medical issues related to contract negotiations with health care providers * Determining if ...

Network Health WI

Associate Medical Director

Menasha, WI · On-site +1

... of utilization review and quality assessment processes * Provide medical consultation as requested ... Medical issues related to contract negotiations with health care providers * Determining if ...

Trilliant Food & Nutrition, LLC

Buyer

Little Chute, WI · On-site

Review and place contracts and subcontracts. * Prepare cost-benefit analysis reports for review by ... Uninterrupted and efficient flow of requested materials and services through utilization of lean ...

Trilliant Food & Nutrition

Buyer I

Little Chute, WI

Review and place contracts and subcontracts. Prepare cost-benefit analysis reports for review by ... Uninterrupted and efficient flow of requested materials and services through utilization of lean ...

Trilliant Food & Nutrition, LLC

Buyer I

Little Chute, WI · On-site

$60K - $70K/yr

... • Review and place contracts and subcontracts. • Prepare cost-benefit analysis reports for ... utilization of lean processes and automation. • Build internal supplier loyalty through positive ...

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All JobsContract Utilization Review JobsContract Utilization Review Jobs in Appleton, WI

Contract Utilization Review information

See Appleton, WI salary details

$20

$41

$67

How much do contract utilization review jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for contract 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 in the Contract Utilization Review position, and why are they important?

To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.

What does a typical day look like for someone working in Contract Utilization Review?

A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.

What is a Contract Utilization Review job?

A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.

What are the most commonly searched types of Utilization Review jobs in Appleton, WI? The most popular types of Utilization Review jobs in Appleton, WI are:
What are popular job titles related to Contract Utilization Review jobs in Appleton, WI? For Contract Utilization Review jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Appleton, WI look for? The top searched job categories for Contract Utilization Review jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Contract Utilization Review jobs? Cities near Appleton, WI with the most Contract Utilization Review job openings:
Contract Utilization Review jobs near you
Associate Medical Director (Menasha)

Associate Medical Director (Menasha)

Network Health

Menasha, WI • On-site

Full-time

Posted 3 days ago

Job description

In support of the CMO, the Associate Medical Director is responsible for the administration of procedures, protocols, and standards regarding the efficiency and quality of the health care delivered to Network Health (NH) members. This individual will be chair of at least 3 committees related to quality and accreditation.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel is required occasionally for the position.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday, weekend coverage required on rotational basis.

Job Responsibilities
  • Assist the CMO with monitoring availability, appropriateness, and necessity of care rendered by participating providers and by out-of-plan providers.
  • Participate in oversight and clinical decision making of the UM program, including but not limited to rendering denial determinations for services not considered medically necessary or experimental/investigation/unproven in accordance with regulatory and quality standards.
  • Contribute to the development of quality care guidelines, internal peer review procedures, and the evaluation of medical care evaluation studies under the NHP quality assurance programs. In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality assessment processes.
  • Provide medical consultation as requested for:
    • Medical/legal issues
    • Member grievance procedures
    • Development and implementation of new benefit packages and the interpretation of covered benefits in NHP contracts
    • Medical issues related to contract negotiations with health care providers
    • Determining if services to members/enrollees meet medical criteria
  • Promote positive relationship between NHP and medical community.
  • Serve as liaison between NHP and providers regarding matters of medical policy and medical administration.
  • Serve as spokesperson for NHP in the medical community and maintain appropriate contact with professional health care organizations.
  • Participate in the ongoing recruitment of plan physicians.
  • Respond to physicians and other provider inquiries and complaints within established guidelines of the Executive Committee and Board of Directors.
  • Assist in the development of appropriate medical guidelines and parameters for claims review.
  • Assist in the training of NHP staff on matters relating to medical guidelines.
  • Oversight responsibility for monitoring and evaluating Medicare Special Needs Plan Model of Care effectiveness.
  • Perform second level review of provider appeals and disputes.
  • Serve on committees as coordinated with the CMO.
  • Assist in strategic planning targeted towards plan growth initiatives.
Job Requirements
  • Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction.
  • Member in good standing of the local medical community. An active practitioner of medicine in the NHP service areas.
  • Must possess a thorough knowledge of the health professional and facilities and standards of practice of medicine in NHP's service area.
  • Must possess sufficient medical experience and other experience, including knowledge of the Medicare program, to review organization determinations involving medical necessity.
  • Board certified in an ABMS medical specialty required.

Network Health is an Equal Opportunity Employer.

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

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