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Remote Nicu 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 ... WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be ...

Bellin

Application Analyst - ClinDoc

Green Bay, WI · On-site +1

  • Medical

  • Retirement

  • PTO

Remote / Hybrid options available. 1920 Libal St, Green Bay, WI 54301 Shift Hours: 1.00 FTE (40 ... neonatal intensive care service. As a Bellin Health team member, you'll enjoy top-notch benefits ...

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 ... WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be ...

EnsoData

Product Manager - Software Medical Devices

Madison, WI · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... the ICU or through wearables, to detecting and capturing seizure data, to providing earlier ... Comfortable working with remote teams and/or hybrid office environments. * Demonstrated qualities ...

EnsoData

Backend Software Engineer

Madison, WI · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... the ICU or through wearables, to detecting and capturing seizure data, to providing earlier ... Remote and flexible schedule - we are a remote company with hybrid options and support for flexible ...

NV5

Remote Sensing Technician

Sheboygan Falls, WI · Remote

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

At NV5 Geospatial, we are a collaboration of intelligent, innovative thinkers who care for each ... Proficient and experienced in utilization of cloud-based technology * Capable of independent ...

NV5

Remote Sensing Technician

Sheboygan Falls, WI · On-site +1

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

At NV5 Geospatial, we are a collaboration of intelligent, innovative thinkers who care for each ... Proficient and experienced in utilization of cloud-based technology * Capable of independent ...

Rogers Behavioral Health

Care Coordinator 1

Oconomowoc, WI · On-site +1

$19.25 - $26/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Summary: The care coordinator serves as a patient advocate and point of contact when a ... Utilization Review. * Patient Financial Services. * Health Information Management. Be available and ...

EnsoData

Staff Engineer - Full Stack

Madison, WI · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... the ICU or through wearables, to detecting and capturing seizure data, to providing earlier ... Communication: Ability to communicate in a remote environment that strives to be diverse and ...

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Remote Nicu Utilization Review information

What is a remote NICU utilization review nurse?

A Remote NICU Utilization Review nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of care provided to newborns in Neonatal Intensive Care Units (NICU) from a remote location. They review patient records, treatment plans, and hospital stays to ensure that the care provided meets established clinical guidelines and insurance policies. This role helps optimize patient outcomes, control healthcare costs, and facilitate communication between healthcare providers, insurers, and families. Working remotely, these nurses use secure digital platforms to access medical records and collaborate with medical teams.

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

To excel as a Remote NICU Utilization Review Nurse, you need a valid RN license, strong clinical expertise in neonatal intensive care, and experience with utilization management practices. Familiarity with case management software, electronic health records (EHRs), and UR-specific platforms such as InterQual or MCG is essential. Outstanding critical thinking, attention to detail, and effective written and verbal communication set top performers apart. These skills ensure accurate assessments, regulatory compliance, and optimized patient outcomes while working remotely in a highly specialized healthcare environment.

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

In a remote NICU Utilization Review position, professionals often encounter challenges such as ensuring thorough communication with clinical teams, navigating different electronic health record (EHR) systems, and maintaining up-to-date knowledge of evolving NICU care standards. Successfully managing these challenges typically involves establishing clear communication channels with onsite staff, participating in regular virtual team meetings, and dedicating time for ongoing education and training. Proficiency in telehealth technologies and strong organizational skills are also essential for accurate documentation and timely case reviews.

What is the difference between Remote Nicu Utilization Review vs Remote Pediatric Utilization Review?

AspectRemote Nicu Utilization ReviewRemote Pediatric Utilization Review
CredentialsRN, NICU experience, utilization review certificationRN, pediatric experience, utilization review certification
Work EnvironmentHome-based, healthcare facilities, insurance companiesHome-based, healthcare facilities, insurance companies
Industry UsageHospitals, insurance, healthcare managementHospitals, insurance, healthcare management
Search IntentCompare roles, job requirements, salary, responsibilitiesCompare roles, job requirements, salary, responsibilities

Remote Nicu Utilization Review involves evaluating NICU patient cases to ensure appropriate care and resource use, requiring NICU experience. Remote Pediatric Utilization Review focuses on pediatric cases, requiring pediatric nursing background. Both roles involve reviewing medical necessity and optimizing healthcare resources remotely within the healthcare and insurance industries.

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

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

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

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

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

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

Remote Nicu Utilization Review jobs near you
Infographic showing various Remote Nicu Utilization Review job openings in Wisconsin as of August 2026, with employment types broken down into 2% Internship, 83% Full Time, 10% Part Time, and 5% Contract. Highlights an 100% Remote job distribution.

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted 13 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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