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Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

... utilization review and denial management. Other duties as assigned. EXPERIENCE DESCRIPTION: A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance ...

FROEDTERT HEALTH

RN, Denials Management

Menomonee Falls, WI · On-site

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Prior utilization management, insurance background, and denial management experience is preferred.

Froedtert

RN, Denials Management

Menomonee Falls, WI

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Prior utilization management, insurance background, and denial management experience is preferred.

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Insurance Utilization Review information

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$42

$69

How much do insurance utilization review jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for insurance utilization review in Wisconsin is $42.68, according to ZipRecruiter salary data. Most workers in this role earn between $33.75 and $48.99 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

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

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Wisconsin? For Insurance Utilization Review jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Wisconsin look for? The top searched job categories for Insurance Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Insurance Utilization Review jobs? Cities in Wisconsin with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Wisconsin as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $88,769 per year, or $42.7 per hour.

Utilization Review Specialist-Remote

Wellbrook Recovery

Brookfield, WI • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

Job description

Utilization Review Specialist – Behavioral Health Facility

We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.

Responsibilities:

  • Conduct utilization reviews and obtain prior authorizations from insurance companies

  • Monitor continued stay and discharge criteria for clients

  • Communicate effectively with clinical and administrative teams

  • Maintain accurate and up-to-date documentation

  • Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.

Qualifications:

  • Background or experience in social work, counseling, or behavioral health is preferred

  • Experience in utilization review or case management for behavioral health is preferred

  • Strong communication and organization skills

  • Ability to work efficiently in a fast-paced environment

  • Confident, proactive, and dedicated work ethic

Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues

Benefits:

  • 401(k)

  • Dental insurance

  • Flexible schedule

  • Health insurance

  • Life insurance

  • Paid time off

  • Vision insurance