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Manager Utilization Management Jobs in Wisconsin

Medica

Manager, Clinical Pharmacy (Governance)

Madison, WI · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...

Network Health, Inc

RN Care Manager

Menasha, WI · Remote

Previous experience in case management, utilization management, insurance, or managed care preferred * Experience with Medicare, Medicaid preferred Network Health is an Equal Opportunity Employer

Network Health

RN Care Manager

Menasha, WI · Remote

Previous experience in case management, utilization management, insurance, or managed care preferred * Experience with Medicare, Medicaid preferred Network Health is an Equal Opportunity Employer

Network Health

RN Care Manager

Menasha, WI · On-site

Previous experience in case management, utilization management, insurance, or managed care preferred * Experience with Medicare, Medicaid preferred Network Health is an Equal Opportunity Employer ...

Network Health WI

RN Care Manager

Menasha, WI · On-site +1

Previous experience in case management, utilization management, insurance, or managed care preferred * Experience with Medicare, Medicaid preferred Network Health is an Equal Opportunity Employer ...

Pharmacy Careers

Formulary Management Pharmacist

Milwaukee, WI · On-site

$57.50 - $69/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

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Pharmacy Careers

Formulary Management Pharmacist

Madison, WI · On-site

$58.75 - $70.50/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

New

Select Medical

Case Manager - Inpatient Rehab

Madison, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...

GQR Global Markets

RN Case Manager

Appleton, WI · On-site

$1.8K - $1.9K/wk

  • Medical

  • Dental

  • Vision

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Appleton, Wisconsin Start Date: August 23, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1847 ...

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Showing results 21-40

All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Wisconsin

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 Aug 16, 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?

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 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 some common challenges faced by a manager 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 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 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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $91,863 per year, or $44.2 per hour.

Director of Acute Care Patient Transitions

ThedaCare

Neenah, WI • On-site

Full-time

Re-posted 16 days ago

ThedaCare rating

6.6

Company rating: 6.6 out of 10

Based on 128 frontline employees who took The Breakroom Quiz

569th of 887 rated healthcare providers

Job description

Why ThedaCare?
Living A Life Inspired!
Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.
At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.
Benefits, with a whole-person approach to wellness -
  • Lifestyle Engagement
    • e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support

  • Access & Affordability
    • e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!
Summary :
This Director Acute Care Patient Transitions is responsible for implementing and directing the day-to-day operation of patient care transitions through the ThedaCare Acute Care facilities. The Director enables and leads their team to maintain defect-free patient flow as they transition into, through and out of the acute care facilities. ThedaCare's mission and vision, will provide the framework to optimize appropriate utilization of ThedaCare services and resources during a person's acute care journey. The Director will be accountable for their team to maintain standards of patient care resulting in top-decile zero defect results. The Director will have a matrix alignment with provider, nursing, quality, and operational leaders.
Job Description:
This director role would oversee the Chaplains , Care Managers, Social Workers, Trauma Social Workers for the hospital system, but mainly the Neenah and Appleton locations.
KEY ACCOUNTABILITIES
  • Provides strategic planning, program development, labor management, and overall operational administration of the department in alignment with delivering top decile quality care.
  • Effectively directs team members in a manner consistent with ThedaCare policies and values.
  • Ensures the recruitment and retention of competent team members to meet the needs of the business operations of the department and fulfill our mission.
  • Oversees and ensures accuracy of time and attendance and payroll practices.
  • Maintains highly effective inpatient discharge planning, utilization management, and communication among payers, providers, and organizations.
  • Sets performance targets aligned with ThedaCare system initiatives, mission, and vision and monitors performance targets.
  • The leader creates effective action plans for process improvement utilizing quality operation system (QOS) framework. Develops and leads implementation of workflows to maintain system targets for LOS and patient flow.
  • Aligning and collaborating with post-hospital care teams to efficiently transition patients to their next level of care.
  • Ensures defect free navigation of patients from all acute care facilities Provides regular reporting of quality metrics and KPI performance to senior leadership.
  • Plans, organizes, implements, and evaluates delivery of care management and discharge planning to ensure appropriate utilization management to minimize denials and appeals.
  • Leads care transition processes for clinical quality, cost-improvement initiatives, and maintains top decile performance for re-hospitalizations in support of ThedaCare's system goals and vision

QUALIFICATIONS
  • Master's degree in Nursing, Social Work (MSW), Healthcare Administration, Public Health, or related healthcare field required or Nursing degree with progressive leadership experience in care management. Equivalent combination of education and experience in care management leadership will be considered.
  • Active license as RN, APSW, or other clinically relevant healthcare professional.
  • Current certification in Case Management by professional certifying organization (or agreement to successfully achieve certification within 6 months of hire)
  • 5 years of progressive healthcare experience in care management, utilization management, or care transitions leadership with demonstrated accountability for system-level clinical, operational, and financial outcomes.

PHYSICAL DEMANDS
  • Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
  • Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

WORK ENVIRONMENT
  • Climate controlled office setting with daily movement throughout the hospital campus
  • Interaction with department members and other healthcare providers

Scheduled Weekly Hours:
40Scheduled FTE:
1Location:
ThedaCare Regional Medical Center - Neenah - Neenah,WisconsinOvertime Exempt:
YesWorker Shift Details:
Days

What ThedaCare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About ThedaCare

Sourced by ZipRecruiter

We want to make exceptional care effortless for our patients. At ThedaCare, that means going above and beyond treating a particular condition – it means helping you achieve better health for life. You and your family are at the center of everything we do, from prioritizing your schedule when making appointments to designing our facilities for your comfort and convenience. Remaining proactive in your care allows us to better predict and prevent disease before complications arise, and when it comes to making important health-related decisions, we are here to support you. In every interaction, we want you to have full confidence the care you receive is purposeful, cost-effective and will help you continue enjoying life as you’ve planned it. ThedaCare is the third largest healthcare employer in Wisconsin, and the largest employer in Northeast Wisconsin with over 7,000 team members.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Neenah, WI, US

Year founded

1909

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