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Director Utilization Management Jobs in Wisconsin

Texas Health Action

WI · On-site

$210.60 - $257.40/hr

Provide direct patient care hours for all services as outlined in the THA Scope of Services ... utilization management. * Oversee clinical emergencies in clinic: syncope, anaphylaxis, drug ...

Advocate Aurora Health

Case Manager

Cudahy, WI · On-site

$19.50 - $25.25/hr

... and utilization management (UM) activities. Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best ...

Elevance Health

Cost of Care Director

Waukesha, WI

$109K - $195K/yr

... utilization management efforts, new products, annual benefit design participation, and financial ... Director Equivalent Workshift: Job Family: PND > Network Contracting Please be advised that ...

JobRx, Inc.

WI · On-site

$130 - $195/hr

Additionally, this leader serves as the Residency Program Director (RPD) for the pharmacy's PGY-1 ... utilization * Managing the pharmaceutical supply chain to assure pharmacy has the necessary ...

Elevance Health

Cost of Care Director

Waukesha, WI · On-site

$109K - $195K/yr

Cost of Care Director Location: This role requires associates to be in-office 3 days per week ... utilization management efforts, new products, annual benefit design participation, and financial ...

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Director Utilization Management information

See Wisconsin salary details

$18.2K

$52.8K

$84.8K

How much do director utilization management jobs pay per year?

As of Jul 27, 2026, the average yearly pay for director utilization management in Wisconsin is $52,811.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,400.00 and $60,600.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What is a Director Utilization Management job?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a Director Utilization Management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

What are the most commonly searched types of Utilization Management jobs in Wisconsin? The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Director Utilization Management jobs in Wisconsin? For Director Utilization Management jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Director Utilization Management jobs in Wisconsin look for? The top searched job categories for Director Utilization Management jobs in Wisconsin are:
Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Wisconsin as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 2% Temporary, and 1% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $52,811 per year, or $25.4 per hour.
Manager, Health Plan Utilization Management - RN

Manager, Health Plan Utilization Management - RN

Sanford Health

Marshfield, WI

Full-time

Posted 13 days ago

Sanford Health rating

6.8

Company rating: 6.8 out of 10

Based on 538 frontline employees who took The Breakroom Quiz

493rd of 890 rated healthcare providers

Job description

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.

Work Shift:

Scheduled Weekly Hours:

40

Compensation:

Union Position:

No

Department Details

Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a diverse member population while ensuring compliance with CMS, NCQA, and state/federal guidelines.

Summary

Responsible for the day to day oversight of department function both in terms of provision of service and providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are followed effectively and efficiently.

Job Description

Considered an expert resource with the centers for Medicare and Medicaid services (CMS). Coordinates authorization/certification of care for designated populations to establish medical necessity and ensure maximum reimbursement while maintaining a high level of customer satisfaction. Actively involved in reviewing information submitted by internal or external referral sources regarding a variety of cases which have the potential to develop into complex and/or costly scenarios and assisting the finance department in understanding the financial implications of these conditions. Additionally includes admission certification, continued stay authorization, clinical documentation improvement, and interaction with payers. Additional duties include management of medical denials, appeals, and grievances.Understand and provide insight into evaluating current process improvement strategies including quality, methods, and ability to maintain focus on the continuous improvement of processes, products and services. Manage processes to support attainment of goals within department and organization. Knowledgeable of industry standards, governing bodies, and regulations. Adjusts to new or changing assignments, processes, and people. Being a positive role model for staff to coach, educate and support both the employees and organizational growth. Determines individual and team competency requirements, vulnerabilities, and learning needs. Assumes management responsibilities such as payroll, scheduling, day-to-day staffing and crucial conversations in collaboration with human resources and leadership. Identifies opportunity for personal and professional growth and pursues educational opportunities.

Qualifications

Bachelor's degree in nursing required. Master's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Four years of clinical nursing experience required. Two years experience as a case manager preferred. One year of leadership/management experience preferred. Experience in medical necessity review preferred.
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Certification is encouraged and may be required depending on specialty or service area.

Sanford is an EEO/AA Employer M/F/Disability/Vet.


If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to talent@sanfordhealth.org.

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About Sanford Health

Sourced by ZipRecruiter

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Industry

Health care and social assistance and hospitals

Company size

10,000+ Employees

Headquarters location

Sioux Falls, SD, US

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