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Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

Champion Care

Case Manager

Milwaukee, WI · On-site

$20 - $24/hr

If you have experience as a SNF Case Manager, Insurance Authorization Specialist, Managed Care Coordinator, Utilization Review Specialist, or Healthcare Authorization Coordinator, we encourage you to ...

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

Basic knowledge and understanding of medical/clinical review processes (i.e., Appeals/Utilization ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

Champion Care

Case Manager

Milwaukee, WI · On-site

$20 - $24/hr

If you have experience as a SNF Case Manager, Insurance Authorization Specialist, Managed Care Coordinator, Utilization Review Specialist, or Healthcare Authorization Coordinator, we encourage you to ...

UnitiMed

RN Case Manager

Mequon, WI · On-site

Day 1 Insurance * * Cigna medical, MetLife dental and vision insurance * * License reimbursement ... Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the ...

New

Eden Senior Care

MDS Coordinator

Oshkosh, WI · On-site

$80K - $90K/yr

... 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 ...

Ourhrconnect

$309K - $413K/yr

Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 11, 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:
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Insurance Utilization Review jobs near you
Case Manager

Case Manager

Champion Care

Milwaukee, WI • On-site

$20 - $24/hr

Full-time

Posted 27 days ago

Job description

Case Manager – Skilled Nursing & Post-Acute Care
Managed Care | Insurance Authorization | Medicare & Medicaid
$20–$24 per hour | Full-Time

Are you experienced in skilled nursing case management, insurance authorizations, managed care, or healthcare coordination? Champion Care is seeking a highly organized and detail-oriented Case Manager to support our skilled nursing and post-acute care facilities by managing insurance authorizations, communicating with payers, and helping ensure strong patient and reimbursement outcomes.

This role is critical in reducing denials, maintaining coverage, coordinating care, and supporting successful transitions for our residents.

If you have experience as a SNF Case Manager, Insurance Authorization Specialist, Managed Care Coordinator, Utilization Review Specialist, or Healthcare Authorization Coordinator, we encourage you to apply.

What You’ll Do

As a Case Manager, you will serve as a key connection between our facilities, clinical teams, and insurance providers.

Key Responsibilities
  • Manage insurance authorizations, updates, concurrent reviews, and appeals for Medicare, Medicaid, Managed Care, and commercial insurance plans
  • Review patient documentation and clinical updates to support approvals and continued stay reviews
  • Track admissions, re-admissions, discharge planning, and changes in condition
  • Communicate with insurance case managers to ensure timely approvals and minimize denials
  • Submit and manage NOMNCs, ABNs, and required payer documentation
  • Coordinate approvals for therapy services, equipment, and specialized care needs
  • Monitor payer portals and maintain accurate authorization records
  • Collaborate with nursing, therapy, admissions, MDS, and billing teams to quickly resolve insurance or coverage concerns
  • Participate in daily and weekly workflow meetings to prioritize cases and improve outcomes
  • Support strong reimbursement processes and positive patient experiences
What We’re Looking For
  • Experience in case management, insurance authorizations, utilization review, managed care, or healthcare coordination preferred
  • Skilled nursing facility (SNF) or post-acute care experience strongly preferred
  • Knowledge of Medicare, Medicaid, and managed care processes
  • Strong organizational skills with ability to manage multiple priorities and cases
  • Detail-oriented with a strong sense of urgency and follow-through
  • Excellent communication and problem-solving skills
Why Join Champion Care
  • Competitive pay: $20–$24 per hour
  • High-impact role tied directly to patient outcomes, reimbursement, and census success
  • Opportunity for growth within a multi-facility healthcare organization
  • Structured team environment with strong operational support
  • Collaborative culture focused on quality care and teamwork

Champion Care is an Equal Opportunity Employer (EOE). We are committed to creating an inclusive environment for all employees and applicants and do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other protected status.

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