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Manager Utilization Management Jobs in Appleton, WI

Network Health, Inc

COB & Recovery Analyst

Menasha, WI · On-site +1

Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management ...

Network Health WI

COB & Recovery Analyst

Menasha, WI · On-site +1

Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management ...

Network Health

COB & Recovery Analyst

Menasha, WI · On-site +1

Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management ...

Ducommun

Master Scheduling Manager

Appleton, WI · On-site

This position serves as the central coordination pointbetween Sales, Program Management, Production ... ERP system utilization. * Maintain accurate planning parameters within the ERP/MRP system.

Ducommun

Master Scheduling Manager

Appleton, WI · On-site

This position serves as the central coordination pointbetween Sales, Program Management, Production ... ERP system utilization. * Maintain accurate planning parameters within the ERP/MRP system.

Network Health, Inc

Claims Analyst II

Menasha, WI · On-site +1

Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.

Network Health

Claims Analyst II

Menasha, WI · On-site +1

Keeps current on group contracts specifics, provider discounts, percentages and per diems, enrollee certificates and agreements, authorizations and other utilization management policies, etc.

New

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 ...

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Showing results 21-40

All JobsUtilization Management 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 Aug 7, 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?

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 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 July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 1% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $88,802 per year, or $42.7 per hour.

COB & Recovery Analyst

Network Health, Inc

Menasha, WI • On-site, Remote

Full-time

Posted 9 days ago

Job description

Network Health’s success is rooted in its mission to create healthy and strong Wisconsin communities. Network Health is seeking a COB and Recovery Analyst who will use their advanced knowledge of refunds and recoveries and Medicare Part D coordination of benefits to maintain and drive improvements to our refund and recovery operations and Medicare Part D COB process.

Individuals in this role will help develop departmental policies and procedures to be followed. Investigates potential refunds and processes requests from Providers and Members due to overpayment or inaccurate payments due to COB or various other reasons. Medicare Part D COB is responsible for accurate coordination to ensure our PBM has correct information, preventing members from prescription delays.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha will be required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

  • Maintain reports for tracking voluntary refunds, recoup requests and the negative vendor report
  • Keeps current on all business programs, including, products offered, group contracts and certificates, provider discounts, percentages and per diems, authorizations, and other utilization management policies, etc.
  • Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution.
  • Reviews and follows up on open work items to ensure resolution is within established timeframes
  • Works closely with refunds and recoveries to identify root-cause for COB related refunds and recoveries
  • Assumes responsibility for accuracy, timeliness and efficiency of COB claims following established guidelines
  • Assist other departments with COB/Medicare Part D appropriate claims payment questions and helps resolve claims adjudication disputes related to COB
  • Identifies and reports issues with COB/MSP identification or processing training and assists in addressing COB training opportunities.
  • Works professionally with members, employers, providers, other insurance carriers and CMS with regard to verification and update of member information to ensure accuracy
  • Manage monthly and annual Medicare Part D letters and corresponding updates with ESI
  • Responsible for complete and accurate documentation of all information received in all applicable member records and databases
  • Assists leadership in decision-making and provides all relevant information accurately and timely
  • Ensures department desk procedures related to role are current and complete
  • Review and respond to CMS Demand Letters for group health plans
  • Assists in addressing training opportunities
  • Actively participates in shared accountability and commitment for departmental and organization-wide results. Support departmental/team goals and objective

Job Requirements:

  • Minimum of 3 years combined operations/customer service experience within the health insurance industry
  • 1-3 years COB, Claims, Refunds and Recoveries or related work
  • Excellent communication, critical thinking, and decision-making skills
  • Knowledge of process improvement/maximum operational efficiency preferred
  • Proficiency in MS Word, Excel, Outlook
  • Working knowledge of COB, MSP and Medicare Part D

Network Health is an Equal Opportunity Employer.

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