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Manager Of Utilization Management Jobs in Wisconsin

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Manager Of Utilization Management information

See Wisconsin salary details

$39.4K

$91.9K

$169.1K

How much do manager of utilization management jobs pay per year?

As of Aug 25, 2026, the average yearly pay for manager of utilization management in Wisconsin is $91,863.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $110,500.00 per year, depending on experience, location, and employer.

What is the difference between Manager Of Utilization Management vs Utilization Review Nurse?

AspectManager Of Utilization ManagementUtilization Review Nurse
CredentialsRN, sometimes with management certificationsRN, with clinical experience
Work EnvironmentAdministrative, overseeing teams and policiesClinical, performing reviews and assessments
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Primary FocusManaging utilization review processes and team supervisionConducting individual patient reviews and assessments

The main difference is that the Manager Of Utilization Management oversees the entire utilization review process and team management, while the Utilization Review Nurse focuses on performing clinical reviews of patient cases. Both roles require RN credentials and work within healthcare or insurance settings, but their responsibilities and focus areas differ significantly.

What does a Manager Of Utilization Management do?

A Manager of Utilization Management oversees the review and approval of healthcare services to ensure they are medically necessary and appropriate. They coordinate with healthcare providers, analyze utilization data, and ensure compliance with policies, often using electronic health records and case management tools. The role requires strong organizational skills and knowledge of healthcare regulations.
Manager Of Utilization Management jobs near you
Infographic showing various Manager Of Utilization Management job openings in Wisconsin as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% In-person job distribution, with an average salary of $91,863 per year, or $44.2 per hour.

Manager, Health Plan Utilization Management - RN

Marshfield, WI • On-site

Sanford Health
Health Care and Social Assistance • 10K+ employees

6.8

Company rating: 6.8 out of 10

Based on 556 frontline employees who took The Breakroom Quiz

498th of 893 rated healthcare providers

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Learn more about Sanford Healthexternal

Full-time

Re-posted 13 days ago

Job description

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.

Work Shift:

Scheduled Weekly Hours:

40

Compensation:

Union Position:

No

Department Details

Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a diverse member population while ensuring compliance with CMS, NCQA, and state/federal guidelines.

Summary

Responsible for the day to day oversight of department function both in terms of provision of service and providing direct supervision of all departmental staff. Maintains a standardization of utilization management process to ensure all policies and procedures are followed effectively and efficiently.

Job Description

Considered an expert resource with the centers for Medicare and Medicaid services (CMS). Coordinates authorization/certification of care for designated populations to establish medical necessity and ensure maximum reimbursement while maintaining a high level of customer satisfaction. Actively involved in reviewing information submitted by internal or external referral sources regarding a variety of cases which have the potential to develop into complex and/or costly scenarios and assisting the finance department in understanding the financial implications of these conditions. Additionally includes admission certification, continued stay authorization, clinical documentation improvement, and interaction with payers. Additional duties include management of medical denials, appeals, and grievances.Understand and provide insight into evaluating current process improvement strategies including quality, methods, and ability to maintain focus on the continuous improvement of processes, products and services. Manage processes to support attainment of goals within department and organization. Knowledgeable of industry standards, governing bodies, and regulations. Adjusts to new or changing assignments, processes, and people. Being a positive role model for staff to coach, educate and support both the employees and organizational growth. Determines individual and team competency requirements, vulnerabilities, and learning needs. Assumes management responsibilities such as payroll, scheduling, day-to-day staffing and crucial conversations in collaboration with human resources and leadership. Identifies opportunity for personal and professional growth and pursues educational opportunities.

Qualifications

Bachelor's degree in nursing required. Master's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Four years of clinical nursing experience required. Two years experience as a case manager preferred. One year of leadership/management experience preferred. Experience in medical necessity review preferred.
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Certification is encouraged and may be required depending on specialty or service area.

Sanford is an EEO/AA Employer M/F/Disability/Vet.


If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to talent@sanfordhealth.org.

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About Sanford Health

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Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

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10,000+ Employees

Headquarters location

Sioux Falls, SD, US

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