Perform utilization review and medical necessity assessments for inpatient admissions and continued stays * Conduct concurrent reviews using established clinical criteria and organizational ...
New
Perform utilization review and medical necessity assessments for inpatient admissions and continued stays * Conduct concurrent reviews using established clinical criteria and organizational ...
New
Perform utilization review and medical necessity assessments for inpatient admissions and continued stays * Conduct concurrent reviews using established clinical criteria and organizational ...
New
Perform utilization review and medical necessity assessments for inpatient admissions and continued stays * Conduct concurrent reviews using established clinical criteria and organizational ...
New
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$72.88 - $108.42/hr
Job Summary and Responsibilities This is a remote position suporting the Central Area Region ... utilization review; Applies strategies within daily operations to identify trends and address gaps ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$72.88 - $108.42/hr
Job Summary and Responsibilities This is a remote position suporting the Central Area Region ... utilization review; Applies strategies within daily operations to identify trends and address gaps ...
Health Services Director - Remote in Wisconsin
Milwaukee, WI · On-site +1
$134K - $230K/yr
... direct reports, both clinical and nonclinical staff * Case management experience ... Disease and utilization management experience * Proven ability in organization, ability to ...
Health Services Director - Remote in Wisconsin
Milwaukee, WI · On-site +1
$134K - $230K/yr
... direct reports, both clinical and nonclinical staff * Case management experience ... Disease and utilization management experience * Proven ability in organization, ability to ...
Health Services Director - Remote in Wisconsin
Milwaukee, WI · Remote
$134K - $230K/yr
... direct reports, both clinical and nonclinical staff * Case management experience ... Disease and utilization management experience * Proven ability in organization, ability to ...
Health Services Director - Remote in Wisconsin
Milwaukee, WI · Remote
$134K - $230K/yr
... direct reports, both clinical and nonclinical staff * Case management experience ... Disease and utilization management experience * Proven ability in organization, ability to ...
Associate Medical Director
Brookfield, WI · On-site +1
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 ...
Associate Medical Director
Brookfield, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
Associate Medical Director
Brookfield, WI · On-site +1
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 ...
Associate Medical Director
Brookfield, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
Associate Medical Director
Menasha, WI · On-site +1
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Appeals Registered Nurse
Madison, WI · On-site +1
... Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your ...
Appeals Registered Nurse
Madison, WI · On-site +1
... Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your ...
$155K - $175K/yr
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
$155K - $175K/yr
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
Sr. Director, Finance -IT
Waukesha, WI · On-site +1
US Remote Dallas and Scottsdale preferred Overview: The Senior Director, Finance IT is a senior ... Conduct regular license and entitlement reviews across all Finance platforms to ensure the ...
Sr. Director, Finance -IT
Waukesha, WI · On-site +1
US Remote Dallas and Scottsdale preferred Overview: The Senior Director, Finance IT is a senior ... Conduct regular license and entitlement reviews across all Finance platforms to ensure the ...
Remote (Wisconsin-based) Reports To: Senior Economic Development Director About WEDC The Wisconsin ... Review projects and provide recommendations related to economic and community development ...
Remote (Wisconsin-based) Reports To: Senior Economic Development Director About WEDC The Wisconsin ... Review projects and provide recommendations related to economic and community development ...
Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. * Clear ...
Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ... Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. * Clear ...
Director Remote Utilization Review information
What is a director of remote utilization review?
A Director of Remote Utilization Review is a healthcare leader responsible for overseeing teams that assess the necessity, appropriateness, and efficiency of medical services, typically from a remote or virtual environment. This role ensures compliance with regulatory guidelines, optimizes resource use, and helps manage healthcare costs while maintaining quality patient care. Directors collaborate with physicians, nurses, and insurance providers to review clinical cases and develop utilization review strategies. They also monitor performance metrics and implement process improvements for remote teams.
How does a director of remote utilization review typically collaborate with clinical and administrative teams to ensure effective patient care management?
A Director of Remote Utilization Review plays a pivotal role in bridging clinical staff, case managers, and administrative teams to optimize patient care and resource utilization. This is often achieved through regular virtual meetings, data sharing, and cross-departmental strategy sessions to review utilization trends and address barriers to care. The director ensures that remote teams adhere to regulatory standards and organizational goals, fostering open communication to streamline workflows and resolve complex cases efficiently. Successful collaboration enhances patient outcomes, reduces unnecessary costs, and maintains compliance, all while supporting a positive remote team environment.
What are the key skills and qualifications needed to thrive as a director of remote utilization review, and why are they important?
To thrive as a Director of Remote Utilization Review, you need in-depth knowledge of healthcare regulations, utilization management processes, and a relevant clinical background, typically supported by an RN or other clinical licensure and experience in case management. Familiarity with utilization review software, electronic health records (EHR), and certifications such as CCM or UM are often required. Leadership, analytical thinking, and strong communication skills are vital for guiding teams and collaborating with stakeholders. These skills ensure effective oversight of remote teams, regulatory compliance, and optimal patient care outcomes.
What is the difference between Director Remote Utilization Review vs Utilization Review Nurse?
| Aspect | Director Remote Utilization Review | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, advanced degree, and management experience | Registered Nurse (RN) license, relevant clinical experience |
| Work Environment | Oversees teams remotely, strategic planning, policy development | Conducts patient reviews, collaborates with healthcare providers, often remote or onsite |
| Employer & Industry Usage | Health insurance companies, managed care organizations | Hospitals, insurance companies, healthcare facilities |
The main difference is that the Director Remote Utilization Review focuses on managing teams and policies remotely, while the Utilization Review Nurse performs clinical reviews directly related to patient care. The director has a broader strategic role, whereas the nurse role is more clinical and operational.
What are the most commonly searched types of Remote Utilization Review jobs in Wisconsin?
The most popular types of Remote Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Director Remote Utilization Review jobs?
Cities in Wisconsin with the most Director Remote Utilization Review job openings:
Full-time
Retirement
Posted 3 days ago
New
UnitedHealth Group rating
7.6
Based on 146 frontline employees who took The Breakroom Quiz
190th of 893 rated healthcare providers
Job description
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Skills and Capabilities:
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Perform utilization review and medical necessity assessments for inpatient admissions and continued stays
- Conduct concurrent reviews using established clinical criteria and organizational guidelines
- Collaborate with physicians, case managers, social workers, and interdisciplinary partners to support patient care coordination and appropriate resource utilization
- Communicate with Medicare, Medicaid, commercial payers, and third-party reviewers regarding authorization and continued stay requirements
- Support denial prevention activities and assist with appeals processes when appropriate
- Apply InterQual, MCG/Milliman, or other evidence-based criteria to evaluate medical necessity
- Maintain compliance with CMS standards and applicable regulatory requirements
- Document utilization review activities and payer communications accurately and timely
- Independently manage assigned workload, prioritize competing demands, and escalate complex issues when needed
- Provide explanations, guidance, and support to team members on utilization management processes and moderately complex issues
Skills and Capabilities:
- Demonstrated analytical, critical thinking, and problem-solving skills
- Effective verbal and written communication skills
- Ability to work independently with minimal guidance on routine and moderately complex responsibilities
- Ability to assess customer needs, identify solutions to non-standard requests, and translate concepts into practice
- Demonstrated organizational skills and ability to manage multiple priorities in a telecommuter environment
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Current, active, unrestricted Registered Nurse (RN) license in the state of Wisconsin (or Compact to include the state of Wisconsin)
- 3+ years of professional nursing experience
- Experience in utilization management, utilization review, case management, care coordination, medical necessity review, or a closely related clinical review function
- Experience evaluating clinical documentation and applying judgment to support appropriate care coordination or resource utilization
- Experience communicating with internal clinical stakeholders, payers, or external partners regarding care coordination, authorization, clinical documentation, or review outcomes
- Ability to work any of our per diem (as needed) shift schedules during our normal business hours (8am - 4:30pm), including flexibility to work both weekday and weekend shifts
Preferred Qualifications:
- Bachelor of Science in Nursing (BSN)
- Utilization Management or Utilization Review experience
- Experience supporting acute inpatient populations, concurrent review, or continued stay review
- Experience using InterQual, MCG/Milliman, or other evidence-based medical necessity criteria
- Experience with Medicare, Medicaid, commercial payer, managed care, authorization, or payer follow-up processes
- Experience working successfully in a remote or telecommuter role
- Denials management, denial prevention, or appeals support experience
- Proven ability to serve as a clinical resource to others and provide guidance on moderately complex issues
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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About UnitedHealth Group
Sourced by ZipRecruiter
Industry
Insurance services
Company size
10,000+ Employees
Headquarters location
Minnetonka, MN, US
Year founded
1977