ZipRecruiter

Log In

1

Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

  • Medical

  • Dental

  • Retirement

  • PTO

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 ...

New

Evolent

Physician Reviewer-Radiology (Part Time)

Madison, WI · On-site

$95 - $100/hr

  • Medical

... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...

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 ...

Acrisure

Claims Assistant

Middleton, WI · On-site

$17 - $19/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services - and more. In the ... Completes vendor referrals by service specialty and utilization review submissions to Rising.

Evolent

Field Medical Director, Vascular Surgeon

Madison, WI · On-site

$130 - $140/hr

  • Medical

... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Ourhrconnect

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

previous pagenext page

Showing results 21-40

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 Aug 13, 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 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 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 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 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $88,769 per year, or $42.7 per hour.

Appeals Registered Nurse

WPS

Madison, WI • On-site, Remote

$30.50 - $40.25/hr

Full-time

Medical, Dental, Retirement, PTO

Posted 3 days ago

New

Job description

Role SnapshotThe Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies. The Appeals RN works in collaboration with the Appeals Examiners/Reps to ensure redeterminations are medically reviewed as needed and completed timely.
Salary Range
66-68k
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Work LocationWe are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you are interested in the following activities:
  • Review and assess first-level appeal cases for denied services, ensuring all relevant medical documentation, coding, and clinical information are provided to support the appeal.
  • Conduct comprehensive medical record reviews to determine the clinical necessity of services and make recommendations for resolution based on clinical guidelines, policy, and the medical necessity of care.
  • Prepare and submit written appeal letters, including comprehensive rationales and supporting clinical evidence.
  • Ensure timely follow-up on all appeals and ensure proper resolution is reached in accordance with company policies and external regulations.
  • Maintain awareness of healthcare laws, regulations, and policies relevant to the appeals process, ensuring all actions comply with regulatory and contractual requirements.
  • Work with and provide directions to Redetermination Representatives to ensure all redeterminations, which require a clinical decision, are responded to within CMS quality and timelines standards.

Minimum Qualifications
  • Associate's (ASN) or Bachelor's Degree in Nursing (BSN).
  • Active RN license, applicable to state of practice in good standing.
  • One (1) or more years of clinical experience in a healthcare setting (hospital/bedside, case management, MDS/Skilled Nursing, etc.).
  • Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
  • Strong attention to detail and organizational skills to manage multiple cases simultaneously.
  • Basic knowledge and understanding of medical/clinical review processes (i.e., Appeals/Utilization Review).
  • Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications
  • Experience working for a Medicare Administrative Contractor (MAC) preferred.
  • One (1) or more years of experience working in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals preferred.
  • Basic Medicare knowledge and/or experience preferred.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer.
  • High speed cable or fiber
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
  • Please review Remote Worker FAQs for additional information.

Benefits
  • Remote and hybrid work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  • Professional and Leadership Development Programs
  • Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
Sign up for Job Alerts
FOLLOW US!
Instagram
LinkedIn
Facebook
WPS Health Blog
Medicare (GHA)
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

Apply