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Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

Dane Street, LLC

WI · On-site

$50 - $90/hr

Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Dane Street, LLC

WI · On-site

$120 - $180/hr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Acadia Healthcare

RN - Admissions Acute

Madison, WI · On-site

... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...

Dane Street, LLC

WI · On-site

$80 - $150/hr

... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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

Ourhrconnect

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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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Wisconsin

Insurance Utilization Review information

See Wisconsin salary details

$21

$42

$69

How much do insurance utilization review jobs pay per hour?

As of Sep 5, 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 is an insurance utilization review?

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 the key skills and qualifications needed to thrive in insurance utilization review?

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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

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 August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, and 4% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $88,769 per year, or $42.7 per hour.

Longshore IME & Peer Review Physicians

Dane Street, LLC

WI • On-site

$50 - $90/hr

Other

Posted 4 days ago

Job description

We are expanding our physician panel for Longshore and Harbor Workers’ Compensation Act (LHWCA) cases and are seeking experienced physicians to perform:

  • Independent Medical Examinations (IMEs)
  • Peer Reviews
  • Or both

Primary demand is in TX, LA, and CA, particularly in Orthopedics, Audiology, Otolaryngology, and Psychiatry. However, we welcome physicians in any specialty with prior Longshore experience.

This is an independent contractor opportunity offering flexible, case-based assignments.

Responsibilities
  • Conduct in-person, objective, defensible IMEs for Longshore cases
  • Perform comprehensive peer reviews of medical records
  • Provide detailed, timely written reports
  • Maintain compliance with LHWCA standards and documentation requirements
Qualifications
  • Active, unrestricted medical license (TX, LA, CA preferred; additional states welcome)
  • US Board-certified or board-eligible in Orthopedics, Audiology, Otolaryngology, and Psychiatry, or related specialty
  • Must be AMA 6th Edition Certified (or willing to become certified)
  • Prior Longshore IME and/or Peer Review experience strongly preferred but not required
  • Strong analytical and report-writing skills
  • Ability to manage case timelines independently
Preferred Experience
  • Experience performing 30+ Longshore IMEs and/or Peer Reviews
  • Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors
  • Multi-state Longshore case experience
Benefits
  • Opportunity for supplemental income
  • Schedule flexibility and predictable work hours – conduct exams and reviews based on your schedule availability
  • No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions.
  • Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise
  • Expanded credentials as an expert in Independent Medical Exams
  • Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal
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