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Nurses In Insurance Jobs in Wisconsin (NOW HIRING)

UWHealth

RN - PACU

Madison, WI · On-site

Join a team of remarkable, dedicated and compassionate nurses in our Adult Inpatient and Outpatient ... An excellent benefits package, including health and dental insurance, paid time off and retirement ...

UWHealth

RN - PACU

Madison, WI · On-site

Join a team of remarkable, dedicated and compassionate nurses in our Adult Inpatient and Outpatient ... An excellent benefits package, including health and dental insurance, paid time off and retirement ...

UW Health

RN - PACU

Madison, WI · On-site

$40.30 - $60.45/hr

Join a team of remarkable, dedicated and compassionate nurses in our Adult Inpatient and Outpatient ... An excellent benefits package, including health and dental insurance, paid time off and retirement ...

UW Health

RN - PACU

Madison, WI · On-site

$40.30 - $60.45/hr

Join a team of remarkable, dedicated and compassionate nurses in our Adult Inpatient and Outpatient ... An excellent benefits package, including health and dental insurance, paid time off and retirement ...

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Nurses In Insurance information

What is the difference between Nurses In Insurance vs Insurance Claims Adjusters?

AspectNurses In InsuranceInsurance Claims Adjusters
Required CredentialsRN license, nursing degreeHigh school diploma or equivalent, licensing may be required
Work EnvironmentInsurance companies, healthcare settings, remote optionsFieldwork, office settings, remote work possible
Industry UsageHealth insurance, disability, life insuranceProperty, casualty, health insurance claims
Job FocusAssessing health-related claims, medical reviewsInvestigating claims, determining coverage validity

While Nurses In Insurance focus on medical assessments and reviews within insurance claims, Insurance Claims Adjusters handle the investigation and evaluation of various insurance claims, including property and casualty. Both roles require understanding insurance policies, but Nurses In Insurance have a healthcare background, whereas Claims Adjusters focus more on claim investigation and settlement processes.

How much do insurance RNs make?

Insurance RNs typically earn between $60,000 and $85,000 annually, depending on experience, location, and certifications. They often work in claims review, risk assessment, or case management, utilizing their nursing skills in an insurance setting.

How to make 150,000 as a nurse?

Nurses can earn $150,000 by gaining advanced certifications, such as Nurse Practitioner or Nurse Anesthetist, working in high-demand specialties, or in roles with overtime and shift differentials. Working in urban areas, hospitals, or private practices with higher pay scales can also increase earnings, especially with experience and additional responsibilities.

What does a nurse do for an insurance company?

A nurse working for an insurance company typically reviews medical records, assesses claims, and determines coverage eligibility based on medical necessity. They may also provide expert opinions, support claims processing, and ensure compliance with healthcare regulations, often using clinical knowledge and documentation skills. Certification as a registered nurse (RN) is usually required for this role.

Can nurses work in insurance companies?

Nurses can work in insurance companies in roles such as case managers, claims reviewers, or health consultants. These positions often require clinical knowledge, strong communication skills, and sometimes certifications like a licensed practical nurse (LPN) or registered nurse (RN).

What are the key skills and qualifications needed to thrive as a Nurse in Insurance, and why are they important?

To thrive as a Nurse in Insurance, you need a solid nursing background, active RN licensure, and experience in case management or utilization review. Familiarity with insurance claims software, medical coding (ICD-10, CPT), and knowledge of healthcare regulations are typically required. Strong analytical, communication, and negotiation skills help nurses effectively review claims and collaborate with patients, providers, and insurers. These competencies ensure accurate claim assessments, cost-effective care, and compliance with regulatory standards in the insurance industry.

What are nurses in insurance?

Nurses in insurance, often called nurse case managers or insurance nurse consultants, are registered nurses who work for insurance companies to review medical claims, assess patient care needs, and coordinate healthcare services. They use their clinical expertise to evaluate treatment plans, ensure medical necessity, and help contain costs while advocating for appropriate patient care. These nurses play a key role in claims management, utilization review, and sometimes help educate policyholders about health and wellness.

How do nurses in insurance typically collaborate with other professionals within the insurance industry?

Nurses in insurance often work closely with claims adjusters, underwriters, medical directors, and case managers to evaluate medical claims, assess risk, and ensure policyholders receive appropriate care. They review medical records, provide clinical insights, and may communicate directly with healthcare providers to clarify treatment details. This collaborative environment requires strong communication skills and the ability to translate clinical knowledge into insurance-related recommendations, making teamwork an essential part of daily responsibilities.
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Nurses In Insurance jobs near you

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Posted 21 days ago

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
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 is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.
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:
  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:
  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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