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Manager Utilization Management Jobs in Appleton, WI

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 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 ...

Endries

Inside Sales Manager

Brillion, WI · On-site

Partner with Sales Operations and Marketing to improve CRM utilization, data quality, reporting accuracy, and lead generation follow-through * Ensure consistent and accurate documentation of customer ...

AllOne Health

Client Relations Manager

De Pere, WI · On-site +1

Deliver presentations, webinars, and training sessions to employees and management on available EAP services and wellness topics. Analyze utilization data to identify trends and recommend strategies ...

Physical Achievement Center

Office Manager

Oshkosh, WI

$55K - $60K/yr

As the Office Manager, you will play a pivotal role in ensuring the smooth flow of patient support, scheduling utilization, and team coordination. You will oversee front desk performance and support ...

AllOne Health

Client Relations Manager

De Pere, WI · On-site

Deliver presentations, webinars, and training sessions to employees and management on available EAP services and wellness topics. * Analyze utilization data to identify trends and recommend ...

SECURA Insurance

Program Manager

Neenah, WI · On-site

Monitor and control resource management for project and program implementation including the utilization of shared resources across multiple projects * Daily, tactical program and project management ...

blueStone

IT Manager

Neenah, WI · On-site

$96K - $117.70K/yr

... the effective utilization of information systems resources. Determines future needs and ... Web development for Intranet and Internet Microsoft SQL Server CRM, preferably Microsoft Dynamics ...

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All JobsManager Utilization Management JobsManager Utilization Management Jobs in Appleton, WI

Manager Utilization Management information

See Appleton, WI salary details

$38.1K

$88.8K

$163.4K

How much do manager utilization management jobs pay per year?

As of May 29, 2026, the average yearly pay for manager utilization management in Appleton, WI is $88,802.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,100.00 and $106,800.00 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 Appleton, WI? The most popular types of Utilization Management jobs in Appleton, WI are:
What are popular job titles related to Manager Utilization Management jobs in Appleton, WI? For Manager Utilization Management jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Appleton, WI look for? The top searched job categories for Manager Utilization Management jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Manager Utilization Management jobs? Cities near Appleton, WI with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Appleton, WI as of May 2026, with employment types broken down into 81% Full Time, 16% Part Time, and 3% Contract. Highlights an 37% Physical, 8% Hybrid, and 55% Remote job distribution, with an average salary of $88,802 per year, or $42.7 per hour.
Supervisor, Healthcare Services (Brown, Fon du Lac, Manitowoc, & Winnebago Counties, WI)

Supervisor, Healthcare Services (Brown, Fon du Lac, Manitowoc, & Winnebago Counties, WI)

Molina Healthcare

Green Bay, WI

$66.46K - $129.59K/yr

Full-time

Posted 3 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

146th of 259 rated insurance

Job description

***Brown, Fon du Loc, Manitowoc, Winnebago Counties, WI***

JOB DESCRIPTION 

Job Summary

Leads and supervises multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care. 

Essential Job Duties


Assists in implementing health management, care management, utilization management, behavioral health and other program activities in accordance with regulatory, contract standards and accreditation compliance. 
Functions as a "hands-on" supervisor, assisting with assessing and evaluation of systems, day-to-day operations and efficiency of operations/services. 
Assists in the coordination of orienting and training staff to ensure maximum efficiency and productivity, program implementation, and service excellence. 
Trains and supports team members to ensure high-risk, complex members are adequately supported. 
Assists with staff performance appraisals, ongoing monitoring of performance, and application of protocols and guidelines. 
Collaborates with and keeps healthcare services leadership apprised of operational issues, staffing, resources, system and program needs. 
Assists with coordination and reporting of department statistics and ongoing client reports, as assigned. 
Local travel may be required (based upon state/contractual requirements). 

Required Qualifications

 At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. r equivalent combination of relevant education and experience. 
Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW).  Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates.  If licensed, license must be active and unrestricted in state of practice.
Ability to manage conflict and lead through change.
Operational and process improvement experience.
Strong written and verbal communication skills.
Working knowledge of Microsoft Office suite.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.

Preferred Qualifications


Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. 
Medicaid/Medicare population experience. 
Clinical experience. 
Supervisory/leadership experience. 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $66,456 - $129,590 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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