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Remote Chiropractic Utilization Review Jobs in Wisconsin

Wisconsin

Facilities Coordinator

Oshkosh, WI · On-site +1

$65K/yr

The position reviews space requests, develops test fits and facility options, evaluates potential ... Hybrid remote work may be available after the successful completion of the initial training period.

Bcbsa

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

ChenMed

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

New

ChenMed

$114K - $144K/yr

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

WPS

Senior IT Security Analyst

Madison, WI · On-site +1

$90K - $115K/yr

... utilization. * Have developed security awareness training programs to educate employees on ... Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ...

ChenMed

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

New

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Remote Chiropractic Utilization Review information

What is a remote chiropractic utilization review?

A Remote Chiropractic Utilization Review is a process where licensed chiropractors or healthcare professionals assess the necessity, efficiency, and appropriateness of chiropractic care provided to patients, but do so remotely—often from home or a centralized office. This review typically involves examining patient records, treatment plans, and billing information to ensure that care meets established clinical guidelines and insurance requirements. The goal is to improve patient outcomes, prevent unnecessary treatments, and ensure that services billed to insurance are medically necessary. Remote reviews use secure online systems and may require coordination with treating chiropractors, insurance companies, and other healthcare providers.

What are the key skills and qualifications needed to thrive as a remote chiropractic utilization review specialist?

To thrive as a Remote Chiropractic Utilization Review specialist, you need a Doctor of Chiropractic degree, a valid state license, and comprehensive knowledge of chiropractic procedures and medical necessity guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certification such as Certified Professional Utilization Review (CPUR) is often required. Strong analytical skills, attention to detail, and effective communication are crucial for evaluating clinical documentation and collaborating with providers. These skills ensure accurate, evidence-based reviews that support appropriate patient care and compliance with insurance standards.

What are some common challenges faced in a remote chiropractic utilization review role, and how can they be managed?

One of the main challenges in a remote Chiropractic Utilization Review role is effectively evaluating clinical documentation to ensure treatment appropriateness without direct patient interaction. Communication with providers can sometimes be limited or delayed, requiring strong written and verbal skills to clarify cases efficiently. Managing time and workflow independently is crucial, as the workload may fluctuate throughout the week. Staying updated with payer guidelines and evidence-based practices is also essential for accurate reviews. Building strong virtual collaboration with team members and providers can help overcome these challenges and maintain high-quality standards.

What is the difference between Remote Chiropractic Utilization Review vs Remote Chiropractic Billing Specialist?

AspectRemote Chiropractic Utilization ReviewRemote Chiropractic Billing Specialist
Primary RoleAssessing medical necessity and appropriateness of chiropractic treatmentsManaging billing, coding, and insurance claims for chiropractic services
Required CredentialsChiropractic license, possibly certifications in utilization reviewMedical billing certifications, knowledge of coding and insurance policies
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare providers or billing companies
Industry UsageUsed by insurance companies and healthcare organizations to approve treatmentsUsed by billing companies and healthcare providers for claims processing

Remote Chiropractic Utilization Review focuses on evaluating the medical necessity of chiropractic treatments, while Remote Chiropractic Billing Specialist handles billing, coding, and insurance claims. Both roles are remote and require healthcare knowledge, but they serve different functions within the chiropractic industry.

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

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

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

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

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

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

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

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

Remote Chiropractic Utilization Review jobs near you
Infographic showing various Remote Chiropractic Utilization Review job openings in Wisconsin as of August 2026, with employment types broken down into 97% Full Time, and 3% Contract. Highlights an 3% In-person, and 97% Remote job distribution.

Utilization Management Nurse RN - Per Diem - Remote

UnitedHealth Group

Waukesha, WI • On-site, Remote

Full-time

Retirement

Posted 2 days ago

New

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 893 rated healthcare providers

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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