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Internship Rn Utilization Review Nurse Jobs in Madison, WI

WPS

Medical Review Nurse Analyst

Madison, WI · On-site +1

$68K - $70K/yr

Active RN license, applicable to state of practice in good standing. * 1 or more years of clinical ... Experience with medical record review or utilization review. Remote Work Requirements * Wired ...

UW Health

Registered Nurse (RN) - Med Surg

Middleton, WI · On-site

... utilization review or quality resources experience in an acute care setting Required * 3 years ... Licensed as a Registered Nurse (RN) in the State of WI or holds a license issued by a jurisdiction ...

TEEMA Group

Registered Nurse (RN)

Portage, WI · On-site

$53 - $63/hr

Registered Nurse (RN)Role Summary Are you a resilient, highly analytical Registered Nurse looking ... Prior professional experience navigating behavioral health, substance utilization programs, or ...

SSM Health

Registered Nurse

Madison, WI · On-site

Participates in ministry and system-wide evaluation of resource utilization as it pertains to wound ... And * Registered Professional Nurse (RN) - Illinois Department of Financial and Professional ...

SSM Health

Registered Nurse

Madison, WI · On-site

Participates in ministry and system-wide evaluation of resource utilization as it pertains to wound ... And * Registered Professional Nurse (RN) - Illinois Department of Financial and Professional ...

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$21

$42

$69

How much do internship rn utilization review nurse jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for internship rn utilization review nurse in Madison, WI is $42.60, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Internship RN Utilization Review Nurse, and why are they important?

To thrive as an Internship RN Utilization Review Nurse, you need a solid foundation in nursing principles, clinical assessment, and case management, typically supported by an RN license and current enrollment in a nursing program. Familiarity with medical coding systems (like ICD-10 or CPT), electronic health records (EHRs), and utilization review software is often required. Strong analytical thinking, communication skills, and attention to detail set candidates apart in this role. These competencies are crucial for ensuring appropriate patient care, regulatory compliance, and effective resource utilization within healthcare organizations.

What types of tasks and learning experiences can I expect as an Internship RN Utilization Review Nurse?

As an Internship RN Utilization Review Nurse, you will typically assist experienced utilization review nurses in evaluating patient records, verifying the necessity of medical procedures, and ensuring compliance with insurance or regulatory guidelines. You'll gain exposure to interdisciplinary communication by collaborating with physicians, case managers, and insurance representatives. This role provides valuable insight into how clinical decisions impact both patient outcomes and healthcare costs, helping you develop analytical and communication skills essential for future advancement. Expect to participate in chart reviews, learn about medical necessity criteria, and attend case discussions as part of your hands-on learning.

What is an Internship RN Utilization Review Nurse?

An Internship RN Utilization Review Nurse is a registered nurse who is in a training or internship phase to learn how to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. This role involves reviewing patient records, coordinating with healthcare providers, and ensuring that treatments meet established guidelines and insurance requirements. The internship provides hands-on experience in the field of utilization review, helping nurses transition from direct patient care to a more administrative or case management-focused role. It is an entry-level opportunity for RNs interested in healthcare quality and cost management.

What is the difference between Internship Rn Utilization Review Nurse vs Utilization Review Nurse?

AspectInternship Rn Utilization Review NurseUtilization Review Nurse
CredentialsRN license, internship or training programRN license, certification in utilization review often preferred
Work EnvironmentTraining setting, supervised, learning-focusedClinical or office setting, independent review tasks
Job ResponsibilitiesAssisting in review processes, gaining experiencePerforming utilization reviews, making coverage decisions

Internship Rn Utilization Review Nurse is a training role for nursing students or new graduates gaining experience, while Utilization Review Nurse is a full-time professional responsible for evaluating medical necessity and coverage. The internship role focuses on learning, whereas the utilization review nurse performs independent assessments in healthcare settings.

What are the most commonly searched types of Rn Utilization Review Nurse jobs in Madison, WI? The most popular types of Rn Utilization Review Nurse jobs in Madison, WI are:
What are popular job titles related to Internship Rn Utilization Review Nurse jobs in Madison, WI? For Internship Rn Utilization Review Nurse jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Internship Rn Utilization Review Nurse jobs in Madison, WI look for? The top searched job categories for Internship Rn Utilization Review Nurse jobs in Madison, WI are:
Internship Rn Utilization Review Nurse jobs near you
Medical Review Nurse Analyst

Medical Review Nurse Analyst

WPS

Madison, WI • On-site, Remote

$68K - $70K/yr

Full-time

Medical, Dental, Retirement, PTO

Posted 10 days ago

Job description

Our Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.
Salary Range$68,000 - $70,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.We 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:
  • Can perform detailed reviews of medical records and documentation to determine the medical necessity of services.
  • Would enjoy reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
  • Want to ensure Medicare providers are correctly reimbursed when documentation supports services rendered.
  • Have prepared written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
  • Would like to educate providers in accordance with the Targeted Probe and Educate (TPE) program.
  • Can monitor the progress of assigned providers and educate on current billing and documentation requirements.
  • Want to ensure compliance with federal and state regulations, CMS guidelines, and company policies.
  • Enjoy staying current on clinical guidelines, medical policy updates, and industry best practices.

Minimum Qualifications
  • Associate's (ASN) or Bachelor's Degree in Nursing (BSN).
  • Active RN license, applicable to state of practice in good standing.
  • 1 or more years of clinical experience in a healthcare setting (hospital, homecare, 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.
  • 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).
  • Familiarity with Medicare guidelines and reimbursement processes.
  • Experience with medical record review or utilization review.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer
  • High speed cable or fiber internet
  • 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 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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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
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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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