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Manager Utilization Management Jobs in Appleton, WI

UnitedHealth Group

Specialty Pharmacist

Green Bay, WI · On-site

$91K - $163K/yr

Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements * Monitor effectiveness and safety of therapy, including lab values, adherence metrics ...

UnitedHealth Group

Specialty Pharmacist

Green Bay, WI

$91K - $163K/yr

Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements * Monitor effectiveness and safety of therapy, including lab values, adherence metrics ...

AFRY

Electrical Department Manager

Appleton, WI

$119K - $153K/yr

Management of electrical engineering staff * Experience managing and being accountable for the billability and utilization of staff to ensure alignment with business and financial performance goals

AFRY

Electrical Department Manager

Appleton, WI

$119K - $153K/yr

Management of electrical engineering staff * Experience managing and being accountable for the billability and utilization of staff to ensure alignment with business and financial performance goals

AFRY

Electrical Department Manager

Appleton, WI · On-site

$119K - $153K/yr

Management of electrical engineering staff * Experience managing and being accountable for the billability and utilization of staff to ensure alignment with business and financial performance goals

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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 Jun 27, 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 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 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 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
Specialty Pharmacist

Specialty Pharmacist

UnitedHealth Group

Green Bay, WI • On-site

$91K - $163K/yr

Full-time

Retirement

Posted 17 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 141 frontline employees who took The Breakroom Quiz

188th of 877 rated healthcare providers

Job description

Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind Caring. Connecting. Growing together.
As a Specialty Pharmacist you will provide high-touch support to patients with complex, specialty diseases, helping them achieve better outcomes through personalized care and consistent engagement. You'll enroll and retain patients, deliver exceptional service, and act as a trusted resource throughout their therapy journey to maximize their access to pharmacy care. Responsibilities include resolving drug-related issues, educating patients and healthcare providers, coordinating clinical and billing projects, and contributing to formulary and compliance efforts. You'll also serve as a specialty medication expert, continuously expanding your knowledge through research and writing.
Primary Responsibilities:
  • Review and manage specialty medication therapies for complex, chronic, or high-cost conditions
  • Provide patient education and counseling, focusing on adherence, administration, side effects, and outcomes
  • Coordinate care with providers, payers, and manufacturers to ensure therapy access and continuity
  • Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements
  • Monitor effectiveness and safety of therapy, including lab values, adherence metrics, and patient-reported outcomes
  • Ensure compliance with REMS and accreditation standards, including documentation and reporting requirements
  • Support quality initiatives and outcomes reporting, meeting specialty pharmacy performance and regulatory metrics

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • ACPE - accredited PharmD degree (highly preferred) or BS of Pharmacy with recent pharmacist work experience
  • Active State of Wisconsin pharmacist license in good standing
  • Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook)

Preferred Qualifications:
  • MS Pharmacy and/or Board certification
  • 1+ years of recent pharmacist experience (hospital setting preferred)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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