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Manager Utilization Management Jobs in Wisconsin

Froedtert

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

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Manager Utilization Management information

See Wisconsin salary details

$39.4K

$91.9K

$169.1K

How much do manager utilization management jobs pay per year?

As of May 29, 2026, the average yearly pay for manager 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 are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Wisconsin? The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Manager Utilization Management jobs in Wisconsin? For Manager Utilization Management jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Wisconsin look for? The top searched job categories for Manager Utilization Management jobs in Wisconsin are:
What cities in Wisconsin are hiring for Manager Utilization Management jobs? Cities in Wisconsin with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Wisconsin as of May 2026, with employment types broken down into 83% Full Time, 15% Part Time, and 2% Contract. Highlights an 38% Physical, 9% Hybrid, and 53% Remote job distribution, with an average salary of $91,863 per year, or $44.2 per hour.
Manager, Health Plan Utilization Management - RN

Manager, Health Plan Utilization Management - RN

Sanford Health

Marshfield, WI

Full-time

Posted 15 days ago

Sanford Health rating

6.8

Company rating: 6.8 out of 10

Based on 521 frontline employees who took The Breakroom Quiz

489th of 864 rated healthcare providers

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:

8 Hours - Day Shifts (United States of America)

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

Sourced by ZipRecruiter

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.

Industry

Health care and social assistance and hospitals

Company size

10,000+ Employees

Headquarters location

Sioux Falls, SD, US

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