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Insurance Utilization Review Jobs in Wisconsin (NOW HIRING)

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 ...

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 ...

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 ...

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 ...

Bellin

Pharmacist - Inpatient Pharmacy

Green Bay, WI · On-site

$56.75 - $68/hr

... therapeutic interchanges, drug utilization review, efficient drug distribution processes ... Top-notch benefits: 401(k) with matching, paid time off, competitive health insurance, wellness ...

Bellin

Pharmacist - Retail Pharmacy

Green Bay, WI · On-site

$56.75 - $68/hr

... therapeutic interchanges, drug utilization review, efficient drug distribution processes ... Top-notch benefits: 401(k) with matching, paid time off, competitive health insurance, wellness ...

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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:
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

Physical Medicine and Rehabilitation Medical Director

Ourhrconnect

$309K - $413K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

Job description


Summary
 As a member of the senior management team, the Physical Medicine and Rehabilitation Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies.
Description
 

Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM.

What You'll Do:

  • Supports operations in the form of case review on both medical and regulatory matters.

  • Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures.

  • Educates staff and medical community on various aspects of medical policy and program administration.

  • May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies.

  • Develops external relationships with the medical community and serves as liaison between these entities and the contractors.

  • Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.

  • Conducts research into new or controversial medical procedures and technology.

To Qualify for This Position, You'll Need the Following:

  • Required Education: Doctorate in a job related field.

  • Required Experience:

    • 5 years post graduate experience in direct patient care.

  • Required Software and tools: Microsoft Office

  • Required Skills and Abilities:

    • Excellent verbal and written communication skills.

    • Excellent customer service, organizational, and presentation skills.

    • Good judgment skills. Proficiency in spelling, punctuation, and grammar.

    • Ability to persuade, negotiate, or influence others.

    • Ability to work as a team member as well as a leader.

    • Knowledge of medical and utilization review techniques.

  • Required Licenses and Certifications: Active state medical license and current board certification in a recognized specialty.

We Prefer That You Have the Following:

  • Health insurance industry experience

  • Experience in INPATIENT Rehabilitation

  • Medicare policy knowledge and experience

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

  • Subsidized health plans, dental and vision coverage

  • 401k retirement savings plan with company match

  • Life Insurance

  • Paid Time Off (PTO)

  • On-site cafeterias and fitness centers in major locations

  • Education Assistance

  • Service Recognition

  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Pay Range Information:

Range Minimum

$206,011.00

Range Midpoint

$309,767.00

Range Maximum

$413,523.00

Pay Transparency Statement:

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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