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Remote Behavioral Health Utilization Review Jobs in Wisconsin

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

  • Medical

  • Dental

  • Retirement

  • PTO

Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

Rogers Behavioral Health

Care Coordinator 1

Oconomowoc, WI · On-site +1

$19.25 - $26/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Utilization Review. * Patient Financial Services. * Health Information Management. Be available and ... their behavior. * Maintain a calm attitude and create a conducive atmosphere in difficult ...

WPS Health Solutions

Appeals Registered Nurse

Madison, WI · On-site +1

  • Medical

  • Dental

  • Retirement

  • PTO

Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ... Health insurance, dental insurance, and telehealth services start DAY 1 * Professional and ...

Elevance Health

Data Scientist Analyst

Waukesha, WI · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Apply machine learning and AI techniques to uncover leading indicators of health utilization trends ... Our values and behaviors are the root of our culture. They are how we achieve our strategy, power ...

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All JobsBehavioral Health Utilization Review JobsRemote Behavioral Health Utilization Review JobsRemote Behavioral Health Utilization Review Jobs in Wisconsin

Remote Behavioral Health Utilization Review information

What is a remote behavioral health utilization review?

A Remote Behavioral Health Utilization Review job involves evaluating behavioral health treatment plans and services to ensure they meet insurance guidelines, medical necessity, and regulatory requirements. Professionals in this role review clinical documentation, assess patient needs, and collaborate with healthcare providers to determine appropriate levels of care. They work remotely, often for insurance companies or healthcare organizations, to authorize or deny coverage based on established criteria. Strong clinical knowledge, attention to detail, and communication skills are essential for success in this role.

What are the typical daily responsibilities for someone working in remote behavioral health utilization review?

In a Remote Behavioral Health Utilization Review role, your daily tasks often include reviewing clinical documentation, assessing medical necessity for behavioral health services, and making authorization or denial recommendations according to established guidelines. You’ll frequently interact with providers, case managers, and insurance representatives to gather information and clarify care requests. Additionally, your day may involve documenting decisions, participating in case review meetings, and staying updated on evolving policies. Working remotely, you'll communicate primarily via secure electronic systems, phone, and video conferencing. This structure typically offers flexibility but also requires strong self-motivation and organization.

What are the key skills and qualifications needed to thrive in remote behavioral health utilization review, and why are they important?

To excel in Remote Behavioral Health Utilization Review, candidates generally need a clinical background such as a nursing or social work license, strong analytical skills, and experience with behavioral health diagnoses and treatment planning. Familiarity with utilization management software, electronic health records (EHRs), and insurance coding systems is often required, along with certifications like CCM (Certified Case Manager) or URAC accreditation being valued. Excellent communication, critical thinking, and organizational skills help professionals handle complex cases and collaborate effectively in a virtual team environment. These competencies ensure accurate review of mental health services, compliance with payer requirements, and optimal patient outcomes.

What are the most commonly searched types of Behavioral Health Utilization Review jobs in Wisconsin?

The most popular types of Behavioral Health Utilization Review jobs in Wisconsin are:

What are popular job titles related to Remote Behavioral Health Utilization Review jobs in Wisconsin?

For Remote Behavioral Health Utilization Review jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Remote Behavioral Health Utilization Review jobs in Wisconsin look for?

The top searched job categories for Remote Behavioral Health Utilization Review jobs in Wisconsin are:

What cities in Wisconsin are hiring for Remote Behavioral Health Utilization Review jobs?

Cities in Wisconsin with the most Remote Behavioral Health Utilization Review job openings:

Remote Behavioral Health Utilization Review jobs near you
Infographic showing various Remote Behavioral Health Utilization Review job openings in Wisconsin as of August 2026, with employment types broken down into 2% As Needed, 78% Full Time, 15% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted 12 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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