Madison, WI · On-site
$150 - $190/hr
Valid driver license and car insurance as required by state law. Required: Other as required by ... reviews, clinical assessments, staff education, MDS coordination, and process improvement ...
Madison, WI · On-site
$150 - $190/hr
Valid driver license and car insurance as required by state law. Required: Other as required by ... reviews, clinical assessments, staff education, MDS coordination, and process improvement ...
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 ...
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 ...
Madison, WI · On-site
$73K - $99K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Madison, WI · On-site
$73K - $99K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Madison, WI · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Madison, WI · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Madison, WI · On-site
$72K - $98K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Madison, WI · On-site
$72K - $98K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
| Aspect | Insurance Utilization Reviewer | Insurance Claims Processor |
|---|---|---|
| Primary Role | Review medical necessity and appropriateness of services for insurance coverage | Process and review insurance claims for payment and accuracy |
| Required Credentials | Often requires healthcare or insurance certifications, such as RHIT or CPC | Typically requires claims processing or insurance certifications, like CPC or CPC-H |
| Work Environment | Healthcare settings, insurance companies, or third-party administrators | Insurance companies, healthcare providers, or claims processing centers |
| Industry Usage | Commonly employed in health insurance and managed care | Widely used across health, auto, and property insurance sectors |
The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.
For Insurance Utilization Reviewer jobs in Wisconsin, the most frequently searched job titles are:
The top searched job categories for Insurance Utilization Reviewer jobs in Wisconsin are:
Cities in Wisconsin with the most Insurance Utilization Reviewer job openings:
$150 - $190/hr
Other
Medical, Dental, Life, Retirement, PTO
Posted 12 days ago
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS division as a full-time Senior Director of Operations.
Education:
Required: Graduate of an accredited college or university with a bachelor's in nursing
Experience:
Required: At least 5 years of clinical experience, with 3 or more years of experience with the RAI process
Licenses/Certificates:
Required: Current and unrestricted RN license in state(s) assigned
Required: RAC-CT certification upon hire or within 6 months of hire.
Required: Valid driver license and car insurance as required by state law.
Required: Other as required by federal, state and local standards
Other Requirements:
Proficient knowledge of PDPM and State Case Mix Reimbursement payment systems.
Proficient in CMS Five Star Quality Measures, and Quality RFeporting Program
Strong knowledge in current Medicare and Managed Care requirements and federal, state, and local regulations that affect skilled clinical care delivery.
Ability to work effectively with all persons and disciplines.
Ability to clearly articulate the complexities of RAI assessments and care planning.
Ability to monitor MDS Coordinators and CRS’s to identify areas for growth and provide mentorship for growth, while maintaining accountability for standard operating
procedures and client outcomes.
Must possess strong customer service skills to coordinate service delivery, including attention to clients, sensitivity to issues, identification and resolution of issues to promote positive client outcomes. Initiative, innovation,
and creativity required.
Must have dynamic presentation skills and superior communication skills.
Must have critical thinking skills with the ability to make good decisions and exercise sound clinical and professional judgment, with proven knowledge of quality
improvement concepts and processes.
The Senior Director of Operations provides leadership and oversight to assigned Directors, MDS Coordinators and Clinical Reimbursement Specialists while partnering with facility leadership to drive reimbursement optimization, quality improvement, regulatory compliance, and operational excellence. The role combines direct consulting services with leadership responsibilities to ensure clients achieve measurable and sustainable results.The Senior Director serves as a strategic partner to clients by identifying opportunities for improvement, developing action plans, providing education, and ensuring consulting recommendations translate into sustainable results. This role maintains direct involvement in billable consulting activities, including reimbursement reviews, clinical assessments, staff education, MDS coordination, and process improvement initiatives.
About Us:
At Key Rehab, we’re shaking up rehab services with a fresh, standout approach. We offer a wide range of services, stick to top-notch systems, and work in strategic locations to get the best results for our patients and support our clients' goals. We’re all about clear communication, using our deep experience to deliver therapy that's both effective and affordable. Our reputation is built on great patient care, happy clients and staff, and solid management. We are proud to exceed expectations for patients, families, healthcare providers, and businesses.
We prioritize both exceptional patient care and the well-being of our employees. We are committed to delivering compassionate, results-driven therapy while offering the flexibility and comprehensive benefits needed to thrive in today’s healthcare environment. Our team is large enough to offer competitive pay and benefits but small enough to ensure personalized attention and support for your career aspirations.
Whether you’re looking for a role that accommodates family commitments, travel plans, home projects, or future savings, we provide tailored solutions to fit your lifestyle. Join us and experience a workplace that values your individual needs and career goals. Come experience a rewarding career where you’re valued and supported every step of the way.
We offer a creative, engaging, and flexible work environment, alongside a comprehensive benefits package designed to support your success and well-being:
