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Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

Champion Care

Director of Case Management

Milwaukee, WI · On-site

Monitor and manage insurance authorizations, concurrent reviews, updates, extensions, and appeals ... Monitor Medicare, Medicaid, Managed Care, and commercial insurance utilization. * Analyze length of ...

Champion Care

Director of Case Management

Milwaukee, WI · On-site

Monitor and manage insurance authorizations, concurrent reviews, updates, extensions, and appeals ... Monitor Medicare, Medicaid, Managed Care, and commercial insurance utilization. * Analyze length of ...

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 ...

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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Insurance Utilization Review information

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How much do insurance utilization review jobs pay per hour?

As of Jul 6, 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 June 2026, with employment types broken down into 24% Full Time, 71% Part Time, 4% Contract, and 1% Nights. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution, with an average salary of $88,769 per year, or $42.7 per hour.
Director of Case Management

Director of Case Management

Champion Care

Milwaukee, WI • On-site

Full-time

Medical, Dental, Vision, PTO

Posted 15 days ago

Job description

) Director of Case Management (LPN/RN)
Skilled Nursing & Post-Acute Care | Full-Time
Champion Care is seeking an experienced and highly organized Director of Case Management to oversee clinical case management operations across our skilled nursing and post-acute care facilities. This leadership role is ideal for an experienced LPN or RN with strong MDS, Medicare, managed care, and reimbursement knowledge who understands the critical connection between clinical documentation, payer management, length of stay, and financial performance.
The Director of Case Management will partner closely with facility leadership, MDS teams, admissions, therapy, and business office personnel to optimize reimbursement, improve authorization outcomes, support census growth, and ensure exceptional resident care throughout the post-acute stay.
If you have a background as an MDS Coordinator, Regional MDS Nurse, Case Manager, Clinical Reimbursement Specialist, Managed Care Coordinator, or Director of Case Management, we encourage you to apply.
Key Responsibilities
  • Lead and oversee case management operations across multiple skilled nursing facilities.
  • Provide guidance and support to facility MDS Coordinators and clinical teams regarding reimbursement and payer requirements.
  • Monitor and manage insurance authorizations, concurrent reviews, updates, extensions, and appeals.
  • Review MDS processes and documentation to support accurate reimbursement and regulatory compliance.
  • Collaborate with admissions teams to evaluate referrals and optimize payer opportunities.
  • Monitor Medicare, Medicaid, Managed Care, and commercial insurance utilization.
  • Analyze length of stay trends, denial patterns, and reimbursement opportunities.
  • Partner with therapy, nursing, and interdisciplinary teams to ensure appropriate clinical documentation.
  • Support discharge planning efforts and transitions of care.
  • Assist facilities with complex payer issues, authorization challenges, and reimbursement concerns.
  • Conduct audits and provide education related to case management, reimbursement, and managed care processes.
  • Track key performance indicators and develop action plans to improve outcomes.
  • Participate in weekly reimbursement, Medicare, and managed care review meetings.
  • Ensure compliance with federal, state, and payer-specific regulations.
  • Assist with training, onboarding, and development of facility-based case management and MDS staff.
Qualifications
  • Current LPN or RN license required.
  • MDS experience in a skilled nursing facility setting required.
  • Previous experience as an MDS Coordinator, Case Manager, Clinical Reimbursement Specialist, or similar role preferred.
  • Strong understanding of Medicare, Medicaid, PDPM, Managed Care, and post-acute reimbursement processes.
  • Skilled nursing facility experience required.
  • Ability to analyze clinical and financial data to identify reimbursement opportunities.
  • Strong leadership, communication, and organizational skills.
  • Ability to manage multiple priorities and support multiple facilities.
  • Experience working collaboratively with admissions, therapy, nursing, and business office teams.
Why Join Champion Care
  • Competitive salary based on experience.
  • Paid time off
  • Company-paid health, dental, and vision insurance.
  • Industry-leading bonus program.
  • Opportunity to support and influence multiple facilities across a growing healthcare organization.
  • Collaborative leadership team and strong operational support.
  • Significant opportunities for professional growth and advancement.

Champion Care is an Equal Opportunity Employer (EOE). We are committed to creating an inclusive workplace 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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