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Insurance Utilization Reviewer Jobs in Madison, WI

GB Packaging

Asst Machine Operator

Fort Atkinson, WI · On-site

$15.25 - $18.25/hr

Maximize the utilization of equipment by operating the machinery at available capacity and speed ... For further information, please review the Know Your Rights notice from the Department of Labor.

Fort HealthCare

RN - PACU

Fort Atkinson, WI · On-site

Develops and implements a plan of care for each patient, including appropriate utilization of ... Vison insurance * Dental insurance * Disability insurance * Flexible Spending * Comprehensive ...

Fort HealthCare

RN - PACU

Fort Atkinson, WI · On-site

Develops and implements a plan of care for each patient, including appropriate utilization of ... Vision insurance * Dental insurance * Disability insurance * Flexible Spending * Comprehensive ...

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Showing results 41-60

All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Madison, WI

Insurance Utilization Reviewer information

See Madison, WI salary details

$31.2K

$38.3K

$44.3K

How much do insurance utilization reviewer jobs pay per year?

As of Aug 12, 2026, the average yearly pay for insurance utilization reviewer in Madison, WI is $38,282.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,300.00 and $42,300.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely 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.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Madison, WI? For Insurance Utilization Reviewer jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Madison, WI look for? The top searched job categories for Insurance Utilization Reviewer jobs in Madison, WI are:
What cities near Madison, WI are hiring for Insurance Utilization Reviewer jobs? Cities near Madison, WI with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you

Certified Nursing Aide - Skilled Nursing (East Madison)

Oakwood Village

Madison, WI • On-site

Full-time

Dental, Vision, Retirement, PTO

Re-posted 8 hours ago

Job description

Oakwood Village has an exciting opportunity for qualified candidates to join our Prairie Ridge (East Side of Madison) senior living community facility team as a Certified Nursing Assistant. This position is responsible for personal care of the residents, care of the resident environment special treatments and procedures, reporting, and recording information. This position is accountable to a licensed nurse who has been designated to supervise.
Why Work at Oakwood?
  • Competitive starting pay with shift differentials.
  • Great staff/patient ratios
  • 403B Retirement Plan
  • Dental and Visual Insurance and Paid Time Off offered for staff working 37.5 or more hours every two weeks
  • Continuing Education/Tuition Reimbursement Program, up to 3,000 per year!

ESSENTIAL RESPONSIBILITIES OF A Certified Nursing Assistant (Not intended to be an all-inclusive list)
  • Provides assistance with hygiene, toileting, repositioning, dressing, eating and mobility for assigned residents.
  • Provides timely care. Answers residents signal system promptly and places signal within residents reach.
  • Reports changes in a resident's physical, emotional, and spiritual status to the nurse.
  • Exhibits proper standard precautions while providing care and utilization of PPE (personal protective equipment) as indicated.
  • Assists residents with the restorative nursing program including, but not limited to, passive range of motion and active range of motion, ambulation with appropriate assistive devices, and use of gait belt.
  • Works closely with therapy departments and follows appropriate instructions and recommendations for safe ambulation and transfer of residents.
  • Receives daily assignments.
  • Reviews Care Plan, as well as CNA care sheet to provide care per resident's plan of care.
  • Discusses and reports Care Plan changes on assigned residents to the nurse if changes are indicated.
  • Accurately charts all care provided as indicated per plan of care.

ESSENTIAL QUALIFICATIONS of a Certified Nursing Assistant
  • Talks with people and show understanding of other's views.
  • Learns and applies principles, methods, techniques, and attitudes required in geriatric nursing assistant care.
  • Works in a partnership environment which fosters effective teamwork in meeting the mission of Oakwood.
  • Understands and follows written and oral instructions.
  • Organizes and prioritizes a variety of duties.
  • Observes changes in mental, physical, and spiritual conditions of residents and report any changes to a nurse.

Job Experience/Training required of a Certified Nursing Assistant (Not intended to be an all-inclusive list)
  • Must be a certified nursing assistant through an accredited program and certification current on State Registry.
  • Grade school education required; high school education preferred.

#IND1
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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