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Internship Remote Utilization Review Jobs in Wisconsin

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

... Review, Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your ...

The Tease

Editorial Internship - Spring 2025

Madison, WI · On-site +1

$13/hr

This Internship Application listing is open as of 08.17.24 Resumes will be Reviewed in October of ... Remote work * Industry connections & introductions * Flexible scheduling and hours * Pay: $13/hr ...

WPS Health Solutions

Medical Director

Madison, WI · On-site +1

Three (3) or more years of experience in the health insurance industry, a utilization review firm ... Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ...

Presence

Wisconsin (remote) - School psychologist

Ripon, WI · On-site +1

$46 - $49/hr

... internship/practicum year) * Experience participating in IEP meetings, acting as case manager, and ... An extensive virtual library of peer-reviewed studies and online assessments, including online ...

Bcbsa

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

ChenMed

$114K - $144K/yr

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

WPS

Senior IT Security Analyst

Madison, WI · On-site +1

$90K - $115K/yr

... utilization. * Have developed security awareness training programs to educate employees on ... Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ...

Opportunityalliance

$32 - $34/hr

Clinical Supervisor Maine Crisis Line (MCL) program (Remote - In Maine) Pay range: $32 - $34/hour ... Offers in-the-moment and follow-up clinical consultation , case review, and administrative support ...

Agrace

Benefit & Compensation Analyst (on site)

Madison, WI · Remote

$70K - $87K/yr

Madison, WI Full Time | Day | Monday-Friday | 8am-5pm (option for 1 Day/Week remote) Make a lasting ... This role analyzes market trends, internal data, employee feedback, and program utilization to ...

New

Great American Insurance Group

$110K - $120K/yr

Occasional Travel- may require overnight travel to tri-annual claim reviews and/or departmental ... Excludes seasonal employees and interns.

SHINE Technologies LLC

Licensing Manager

Janesville, WI · On-site +1

$160K - $200K/yr

Hybrid or remote work arrangement will be considered. While our headquarters is located in ... Interface with regulatory agencies in the planning of regulatory engagements, regulatory reviews ...

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All JobsUtilization Review JobsInternship Remote Utilization Review JobsInternship Remote Utilization Review Jobs in Wisconsin

Internship Remote Utilization Review information

What are the main challenges interns face when working remotely in utilization review, and how can they overcome them?

Remote Utilization Review interns often encounter challenges in balancing independent work with effective communication, especially when collaborating with clinical teams or supervisors. Staying organized and proactively reaching out for guidance can help bridge gaps caused by remote settings. Utilizing available digital tools, attending virtual meetings, and participating in team chats fosters connection and learning. Setting a structured daily schedule and seeking regular feedback ensures that interns stay aligned with team goals and develop their review skills efficiently.

What is a remote utilization review internship?

A Remote Utilization Review Internship is a temporary position, often for students or recent graduates, that allows individuals to work remotely while learning about utilization review processes in healthcare. Interns assist in evaluating medical records, ensuring that healthcare services provided to patients are medically necessary and meet established guidelines. They work under the supervision of licensed professionals, gaining experience in medical documentation, insurance policies, and healthcare regulations. This role is ideal for those interested in healthcare administration, nursing, or case management.

What is the difference between Internship Remote Utilization Review vs Utilization Review Specialist?

AspectInternship Remote Utilization ReviewUtilization Review Specialist
CredentialsTypically pursuing or holding relevant certifications (e.g., CCM, RN)Requires active certification and experience in utilization review
Work EnvironmentRemote, internship setting, often part-time or supervisedFull-time, remote or onsite, with more independent responsibilities
Industry UsageEntry-level, training phase within healthcare and insurance sectorsProfessional role with established responsibilities in healthcare management

In summary, an Internship Remote Utilization Review is a training position for individuals gaining experience in utilization review, often with supervision and limited responsibilities. A Utilization Review Specialist is a fully qualified professional responsible for evaluating healthcare services, requiring certifications and more independence in their role.

What are the key skills and qualifications needed to thrive as a remote utilization review intern?

To thrive as a Remote Utilization Review Intern, you need a foundational understanding of healthcare processes, medical terminology, and insurance guidelines, often supported by a relevant degree or coursework in nursing, health administration, or a related field. Familiarity with electronic medical record (EMR) systems, utilization review software, and HIPAA compliance is typically required. Strong attention to detail, analytical thinking, and effective written communication are standout soft skills in this role. These abilities are crucial for accurately reviewing patient cases, ensuring regulatory compliance, and supporting efficient healthcare delivery from a remote setting.

What are the most commonly searched types of Remote Utilization Review jobs in Wisconsin?

The most popular types of Remote Utilization Review jobs in Wisconsin are:

What are popular job titles related to Internship Remote Utilization Review jobs in Wisconsin?

For Internship Remote Utilization Review jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Internship Remote Utilization Review jobs in Wisconsin look for?

The top searched job categories for Internship Remote Utilization Review jobs in Wisconsin are:

What cities in Wisconsin are hiring for Internship Remote Utilization Review jobs?

Cities in Wisconsin with the most Internship Remote Utilization Review job openings:

Internship Remote Utilization Review jobs near you

Appeals Registered Nurse

WPS

Madison, WI • On-site, Remote

$30.50 - $40.25/hr

Full-time

Medical, Dental, Retirement, PTO

Posted 6 days ago

Job description

Role SnapshotThe Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies. The Appeals RN works in collaboration with the Appeals Examiners/Reps to ensure redeterminations are medically reviewed as needed and completed timely.
Salary Range
66-68k
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Work LocationWe are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you are interested in the following activities:
  • Review and assess first-level appeal cases for denied services, ensuring all relevant medical documentation, coding, and clinical information are provided to support the appeal.
  • Conduct comprehensive medical record reviews to determine the clinical necessity of services and make recommendations for resolution based on clinical guidelines, policy, and the medical necessity of care.
  • Prepare and submit written appeal letters, including comprehensive rationales and supporting clinical evidence.
  • Ensure timely follow-up on all appeals and ensure proper resolution is reached in accordance with company policies and external regulations.
  • Maintain awareness of healthcare laws, regulations, and policies relevant to the appeals process, ensuring all actions comply with regulatory and contractual requirements.
  • Work with and provide directions to Redetermination Representatives to ensure all redeterminations, which require a clinical decision, are responded to within CMS quality and timelines standards.

Minimum Qualifications
  • Associate's (ASN) or Bachelor's Degree in Nursing (BSN).
  • Active RN license, applicable to state of practice in good standing.
  • One (1) or more years of clinical experience in a healthcare setting (hospital/bedside, case management, MDS/Skilled Nursing, etc.).
  • Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
  • Strong attention to detail and organizational skills to manage multiple cases simultaneously.
  • Basic knowledge and understanding of medical/clinical review processes (i.e., Appeals/Utilization Review).
  • Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications
  • Experience working for a Medicare Administrative Contractor (MAC) preferred.
  • One (1) or more years of experience working in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals preferred.
  • Basic Medicare knowledge and/or experience preferred.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer.
  • High speed cable or fiber
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
  • Please review Remote Worker FAQs for additional information.

Benefits
  • Remote and hybrid work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  • Professional and Leadership Development Programs
  • Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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Medicare (GHA)
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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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