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Manager Utilization Management Jobs in Milwaukee, WI

Accenture

Clinical Management Manager

Milwaukee, WI · On-site

$94K - $293K/yr

Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...

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 ...

GQR

RN - Case Manager

Racine, WI · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Racine, Wisconsin Start Date: September 13, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1832 ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Milwaukee, WI

Manager Utilization Management information

See Milwaukee, WI salary details

$38.4K

$89.7K

$165K

How much do manager utilization management jobs pay per year?

As of Aug 25, 2026, the average yearly pay for manager utilization management in Milwaukee, WI is $89,668.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,600.00 and $107,900.00 per year, depending on experience, location, and employer.

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 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 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 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 Milwaukee, WI?

The most popular types of Utilization Management jobs in Milwaukee, WI are:

What are popular job titles related to Manager Utilization Management jobs in Milwaukee, WI?

For Manager Utilization Management jobs in Milwaukee, WI, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Milwaukee, WI look for?

The top searched job categories for Manager Utilization Management jobs in Milwaukee, WI are:

What cities near Milwaukee, WI are hiring for Manager Utilization Management jobs?

Cities near Milwaukee, WI with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Milwaukee, WI as of August 2026, with employment types broken down into 84% Full Time, and 16% Contract. Highlights an 100% In-person job distribution, with an average salary of $89,668 per year, or $43.1 per hour.

Utilization Management Nurse RN - Per Diem - Remote

Waukesha, WI • On-site, Remote

UnitedHealth Group
Insurance Services • 10K+ employees

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

191st of 893 rated healthcare providers

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Full-time

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This job post has expired today. Applications are no longer accepted.

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform utilization review and medical necessity assessments for inpatient admissions and continued stays
  • Conduct concurrent reviews using established clinical criteria and organizational guidelines
  • Collaborate with physicians, case managers, social workers, and interdisciplinary partners to support patient care coordination and appropriate resource utilization
  • Communicate with Medicare, Medicaid, commercial payers, and third-party reviewers regarding authorization and continued stay requirements
  • Support denial prevention activities and assist with appeals processes when appropriate
  • Apply InterQual, MCG/Milliman, or other evidence-based criteria to evaluate medical necessity
  • Maintain compliance with CMS standards and applicable regulatory requirements
  • Document utilization review activities and payer communications accurately and timely
  • Independently manage assigned workload, prioritize competing demands, and escalate complex issues when needed
  • Provide explanations, guidance, and support to team members on utilization management processes and moderately complex issues

Skills and Capabilities:
  • Demonstrated analytical, critical thinking, and problem-solving skills
  • Effective verbal and written communication skills
  • Ability to work independently with minimal guidance on routine and moderately complex responsibilities
  • Ability to assess customer needs, identify solutions to non-standard requests, and translate concepts into practice
  • Demonstrated organizational skills and ability to manage multiple priorities in a telecommuter environment

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:
  • Current, active, unrestricted Registered Nurse (RN) license in the state of Wisconsin (or Compact to include the state of Wisconsin)
  • 3+ years of professional nursing experience
  • Experience in utilization management, utilization review, case management, care coordination, medical necessity review, or a closely related clinical review function
  • Experience evaluating clinical documentation and applying judgment to support appropriate care coordination or resource utilization
  • Experience communicating with internal clinical stakeholders, payers, or external partners regarding care coordination, authorization, clinical documentation, or review outcomes
  • Ability to work any of our per diem (as needed) shift schedules during our normal business hours (8am - 4:30pm), including flexibility to work both weekday and weekend shifts

Preferred Qualifications:
  • Bachelor of Science in Nursing (BSN)
  • Utilization Management or Utilization Review experience
  • Experience supporting acute inpatient populations, concurrent review, or continued stay review
  • Experience using InterQual, MCG/Milliman, or other evidence-based medical necessity criteria
  • Experience with Medicare, Medicaid, commercial payer, managed care, authorization, or payer follow-up processes
  • Experience working successfully in a remote or telecommuter role
  • Denials management, denial prevention, or appeals support experience
  • Proven ability to serve as a clinical resource to others and provide guidance on moderately complex issues

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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 hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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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