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Insurance Utilization Review Jobs in Green Bay, WI

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 -Infusion Services

Green Bay, WI · On-site

... 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 ...

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 ...

Ernest Health

Pharmacist - Part Time

Green Bay, WI · On-site

$56.75 - $68/hr

Life insurance * Short-and-long term disability Wellness & Work Life Balance: * Employee Assistance ... Conducts drug utilization reviews and prepares drug review criteria for medical staff approval.

RR Donnelley

VDP Specialist (3rd Shift)

De Pere, WI · On-site

$24.15 - $38/hr

Receive, review, and verify order specs and instructions from the Client Service Rep.Utilize copy ... utilization of programmed logic. Self-motivation and strong organizational skills are required.

RR Donnelley

VDP Specialist (3rd Shift)

De Pere, WI

$24.15 - $38/hr

Receive, review, and verify order specs and instructions from the Client Service Rep.Utilize copy ... utilization of programmed logic. Self-motivation and strong organizational skills are required.

RRD

VDP Specialist (3rd Shift)

De Pere, WI · On-site

$16.50 - $20.25/hr

Responsibilities : • Receive, review, and verify order specs and instructions from the Client ... and utilization of programmed logic. • Self-motivation and strong organizational skills are ...

Eck Industries, Inc.

Simulation Engineer

Manitowoc, WI · On-site

Design gating systems for new and existing jobs through the utilization of CAD modeling. * Perform ... Analyze and develop reports with detailed findings from review of Magmasoft results. * Correlate ...

Pick 'n Save

PHARMACY/PHARMACIST Float Leader

Appleton, WI · On-site

$55.50 - $66.50/hr

D irect the pharmacy team to achieve warehouse utilization goals, avoid unnecessary overstock ... M onitor third-party or insurance profitability; handle third-party problems, rejections, and ...

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Insurance Utilization Review information

See Green Bay, WI salary details

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$41

$67

How much do insurance utilization review jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for insurance utilization review in Green Bay, WI is $41.13, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 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 Green Bay, WI?

For Insurance Utilization Review jobs in Green Bay, WI, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Green Bay, WI look for?

The top searched job categories for Insurance Utilization Review jobs in Green Bay, WI are:

What cities near Green Bay, WI are hiring for Insurance Utilization Review jobs?

Cities near Green Bay, WI with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Green Bay, WI as of August 2026, with employment types broken down into 75% Full Time, 17% Part Time, and 8% Nights. Highlights an 100% In-person job distribution, with an average salary of $85,544 per year, or $41.1 per hour.

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Network Health rating

7.9

Company rating: 7.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

187th of 315 rated insurance

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:
  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
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.

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