Insurance Utilization Review Jobs in Milwaukee, WI

Become a part of our caring community
$10,000 SIGN ON BONUS!
Work Schedule: Full-time/40 Hours
Position Type: On-site
Branch Location: West Allis, WI
This is NOT a remote or work-from-home position. You will sit on-site at our West Allis, WI branch location.
As a Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you will lead and support a team of dedicated clinicians who deliver compassionate, high-quality care in the home setting. By guiding clinical practice, coordinating patient services, and ensuring excellence in every step of the care journey, you'll empower patients to achieve their highest level of independence while helping your team thrive in their roles.
As a Registered Nurse Clinical Manager, you will:

• Oversee clinical operations for the location, including patient care delivery, staff management, documentation quality, and regulatory compliance, working onsite in-office.
• Review referrals, determine admission appropriateness, assign clinicians, and ensure Plans of Care meet patient needs and agency standards.
• Guide, support, and educate clinicians; help goal-set, care planning, and clinical decision-making; and remain available during operating hours for clinical support.
• Ensure clinical documentation, audits, and billing meet Medicare, payer, and company standards; monitor case management quality and outcomes.
• Participate in hiring, training, performance evaluation, coaching, and corrective action for clinical staff.
• Conduct ongoing staff education based on documentation review, utilization review findings, and performance improvement data.
• Coordinate communication among physicians, team members, and caregivers to support care coordination, discharge planning, and outcome achievement.
• Participate in quality improvement, data tracking, budgeting activities, marketing initiatives, and community relationship development.
• Provide direct patient care on a limited basis in exceptional or unplanned circumstances and act as Branch Director in their absence.
• Perform additional tasks to support clinical operations and organizational goals.

Use your skills to make an impact
Required Experience/Skills:

• Graduate of an accredited School of Nursing.
• Current state license as a Registered Nurse.
• Proof of current CPR.
• Valid driver's license, auto insurance and reliable transportation.
• Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment.
• Home health experience is required.
• Management and people leadership experience, required.
• OASIS experience, required.
• Homecare Homebase (HCHB) experience, preferred.
• CMS PDGM billing knowledge or experience, preferred.

Additional Information

• Normal Hours of Operation: M-F / 8a-5p (CT)
• On-Call: Required
• Branch Size: 156 Census (4.5 STAR rating)
• Annual Bonus: Eligible for the annual incentive bonus which has pay-outs both quarterly and annually.

Additional Information
TB Statement:
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Driving Statement:
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$77,200 - $106,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.